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Regional Maternal and Newborn Care Forum Snowcrest Hotel, Arusha, Tanzania 18-23 August 2013 Workshop Report Table of Contents ACRONYMS ................................................................................................................. 3 1.0 INTRODUCTION .................................................................................................... 5 2.0 PRE-FORUM TRAINING OF REGIONAL MASTER TRAINERS ................................ 7 3.0 FORUM PROCEEDINGS ......................................................................................... 7 DAY ONE – 19TH AUGUST 2013 ................................................................................... 8 Opening ceremony ..............................................................................................................8 Status of Maternal Health in the ECSA region ...................................................................... 10 Status of Newborn health in the ECSA region ...................................................................... 10 Harnessing potentials of professional health associations to save maternal and newborn lives ........................................................................................................................................ 11 HBB and HMS demonstration ............................................................................................. 11 Experiences in cascading HBB in the ECSA region ............................................................... 12 Experiences in cascading HMS in Zambia ............................................................................ 13 Uganda experience with PPH Management ......................................................................... 13 Overview of the draft global “Every Newborn” Action Plan ................................................... 14 Overview of Ending Preventable Maternal Death Strategy .................................................... 14 Regional clinical pre-service and in-service education training initiatives ............................... 14 Global evidence on simulation based training ...................................................................... 15 DAY TWO – 20TH AUGUST 2013 ............................................................................... 16 Concurrent training sessions in HBB and HMS ..................................................................... 16 DAY THREE – 21ST AUGUST 2013 ............................................................................. 20 Integration of HMS and HBB .............................................................................................. 20 Knowledge and skills building in quality improvement in maternal and newborn care ............ 20 HBB and HMS certificate award ceremony .......................................................................... 21 DAY FOUR – 22ND AUGUST 2013 .............................................................................. 22 Technical Updates on High Impact Newborn Interventions .................................................. 22 Technical Updates on High Impact Maternal Interventions ................................................... 25 Capacity building of Professional Associations ..................................................................... 26 Respectful maternity care .................................................................................................. 27 DAY FIVE – 23RD AUGUST 2013 ................................................................................ 29 Experiences with developing/establishing a community of practice in MNCH ......................... 29 Introduction to the implementation framework for Survive and Thrive Alliance ..................... 30 Regional and Country level action planning ......................................................................... 31 Closing ceremony.............................................................................................................. 32 APPENDICES ............................................................................................................. 34 APPENDIX 1. FORUM AGENDA ................................................................................. 34 APPENDIX 2. LIST OF PARTICIPANTS ..................................................................... 34 Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 2 APPENDIX 3. COUNTRY ACTION PLANS .................................................................. 54 ACRONYMS AAP AAR ACNM ACOG ACS AMTSL AOGU ASSIST CHX CME CONAMA CoP D&A DJCC EAPA ECSACOG ECSACON ECSA-HC EMONC EMTCT ENAP FIGO GDA GNAP HBB/BAB HIV/AIDS HMC HMS ICM JHPIEGO JSI KMA KMC LDHF MDGs MNCH NEPI OSCE PDSA American Academy of Pediatrics Average Annual Reduction Rate American College of Nurses and Midwives American College of Obstetricians’ and Gynecologists’ Antenatal corticosteroids Active Management of Third Stage Labour Association of Obstetricians and Gynaecologists of Uganda Applying Science to Strengthen and Improve Systems Chlorhexidine Continuous medical education Confederation of African Midwives Associations Community of Practice Disrespect and abuse Directors Joint Consultative Committee East African Pediatric Association East Central and Southern Africa College of Obstetricians’ and Gynecologists’ East Central and Southern Africa College of Health Sciences East Central and Southern Africa Health Community Emergency obstetrics and newborn care Elimination of Mother to Child Transmission of HIV Every Newborn Action Plan International Federation of Gynecology and Obstetric Associations Global Development Alliance Global Newborn Action Plan Helping Babies Breathe/Breathing After Birth Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome Health Ministers Conference Helping Mothers Survive International Confederation of Midwives Johns Hopkins Program for International Education in Gynecology and Obstetrics John Snow International Kenya Medical Association Kangaroo Mother Care Low Dose High Frequency Millennium Development Goals Maternal Newborn and Child Health Nursing Education Partnership Initiative Observed Structured Clinical Examination Plan Do Study Act Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 3 PEPFAR PPH RCQHC RMC SoP ToT USAID WHO US President's Emergency Plan for AIDS Relief Post partum hemorrhage Regional Centre for Quality Health Care Respectful Maternity Care Standard operating procedures Trainer of Trainers United States Agency for International Development World Health Organization Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 4 1.0 INTRODUCTION The Survive and Thrive Initiative is an innovative Global Development Alliance (GDA) which forges partnership between United States midwifery, obstetric, and pediatric associations with USAID, the private sector, and civil society organizations to improve the quality of facility-based maternal, newborn, and child health services to reduce preventable maternal and child deaths in developing countries. In August 2012, a regional orientation workshop was organized to introduce the Survive and Thrive Initiative for maternal newborn and child survival by GDA members to Directors of Health services and senior Ministry of Health officials from member states (members of the DJCC), Regional Center of Quality of Health Care (RCQHC), East Central and Southern Africa Health Community (ECSA-HC) USAID/EA as well as regional professional associations. The regional orientation workshop was organized as a preconference activity of the 6th Best Practices Forum and the 22nd Directors Joint Consultative Committee held in Arusha Tanzania. A subsequent resolution (ECSA/HMC56/R2) was passed in the 56th health ministers’ conference directing the secretariat to ‘support Member States in implementing and coordinating the activities of the Call for Action on Delivering Maternal and Child Health, including the Survive and Thrive initiative’. It is on the foundation of this resolution that the regional organizations’ ECSA-HC and RCQHC resolved to develop a joint concept to implement collaborative activities in response to the Survive and Thrive Initiative. As an initial activity, RCQHC and ECSA-HC cohosted the Regional Maternal and Newborn Care Forum together with at the Snowcrest Hotel, Arusha , Tanzania from 18th -23rd August 2013. The main objectives of the forum were: 1. To strengthen the capacity of Regional Professional Associations to address Maternal, Newborn and Child Health issues 2. To orient participants on quality improvement processes 3. To strengthen the organizational capacity of Professional Associations 4. To deliberate on the formation and coordination of an African maternal and newborn care community of practice To achieve the objectives, technical updates on high impact interventions and best practices; knowledge and skills building sessions on Helping Mothers Survive Bleeding After Birth (HMS/BAB), Helping Babies Breathe (HBB) and Quality Improvement processes; discussions and action planning were included in the forum agenda (Appendix 1). The Forum was attended by 132 participants who included representatives from Ministries of Health; international, regional and national health care professional associations and Global development Alliance (GDA) and development partners (Appendix 2). Sixteen (16) East, Central and Southern African countries Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 5 namely Kenya, Uganda, Tanzania, Lesotho, Mauritius, Malawi, Zambia, Swaziland, Zimbabwe, South Africa, Ethiopia, Seychelles, Botswana, Rwanda, Ghana and Burundi were represented at the Forum. The key outputs of the forum were: Recommendations on scaling up HBB and the way forward in implementing the process 100 health professional trained/updated on the concept of the Survive and Thrive Initiative which included maternal, newborn and child health technical updates and simulation-based training on the active management of the third stage of labour (AMTSL), and management of other complications of pregnancy, delivery and postpartum such as preeclampsia/eclampsia, Infections, Obstructed labor, and post partum hemorrhage (PPH); birth asphyxia, complications of prematurity, and neonatal infections and quality improvement processes Development of regional and country level action plans outlining proposed activities for rolling out high impact maternal and newborn care interventions as well as strengthening professional associations in a bid to improve maternal and new born survival Institutional capacity building needs of regional and national professional associations identified. This report details proceedings of the forum. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 6 2.0 PRE-FORUM TRAINING OF REGIONAL MASTER TRAINERS On 18th August 2013, a pre-forum training of master trainers in helping mothers survive (HMS) simulation materials was conducted. This was aimed at increasing the number of regional trainers on Helping Mothers Survive (HMS) who would be able to support countries in the region in its roll out. The regional trainees were drawn from ECSA-HC, RCQHC and other regional organizations. These trainers were expected to support other global and regional master trainers during the training that was scheduled for Day 2 of the forum. This simulation-based training had various components including; updates on maternal health and PPH, introduction to Mama Natalie birthing simulator; the training tools including flip chart, flow chart, and providers guide. The trainers were taken through the simulation and each given an opportunity to manage a delivery. The trainees were certified after satisfactory demonstration of their skills. HMS demonstration by JHPIEGO team – Photo credit: Laerdal Global Health Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 7 3.0 FORUM PROCEEDINGS DAY ONE – 19TH AUGUST 2013 Opening ceremony The forum was officially opened by the Honorable, Dr. Seifs Rashid, Deputy Minister of Health and Social Welfare, United Republic of Tanzania. In his remarks he noted that a number of ECSA countries are still off track in meeting MDGs 4 and 5, despite research, policies and programmatic improvements made so far. He regretted that 40% of deaths in the under five-year old children occur in the neonatal period. He underscored the need for simple innovations that would effectively address the alarming maternal and newborn deaths and ill health in the region. The Minister appreciated the involvement of the professional associations of various cadres as a means to address these problems and promised the MOHSW commitment to support ECSA in the implementation of the Survive and Thrive Initiative. Delegates at opening ceremony In her remarks, the Director General of ECSA Health Community, Dr. Josephine KibaruMbae said that in view of the slow progress towards the achievement of MDGs 4 and 5, it is imperative that countries adopt innovative and untapped approaches to accelerate the pace of implementation of Maternal and Child health interventions. Given that the high impact interventions are already known, she highlighted that this meeting would not be bringing new ones on the table, but rather discussing the means through which these available approaches can be done differently to give better results. She also emphasized the critical role the professional associations play in addressing the missing gaps of engaging the health professionals in addressing the health challenges. She noted that health workers in both the Public and Private sectors are members of these associations, and their bodies are therefore Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 8 well positioned to influence ethical practices by the health workers. The need to provide respectful skilled care at the facilities was emphasized, as the opposite, ‘disrespectful care’ contributes to the high number of women delivering at home, with attendant high morbidity and mortality. Having a pool of trainers from the diverse associations will help to quickly cascade the trainings among all relevant cadres. She committed support and collaboration of ECSA Health community with other partner with all stakeholders and professional associations to improve the maternal, newborn, and child health. All appropriate health interventions for that improve the welfare of our people will be supported by all means. The Deputy Director of Regional Center for Quality of Health Care (RCQHC) Dr. Wamuyu Maina, underscored the importance of sharing the varied strategies being implemented by countries, lessons learnt, best practices as well as new technical information and innovations that will enable further strides to be made towards improving health care delivery in the region. She added that through this forum, RCQHC will be able to once again respond to its mission of “improving Quality of Healthcare in Africa”, and also uphold health workers enthusiasm to learn as well as explore and forge networking mechanisms between professional health associations, to further improve maternal and child care service delivery. Mr. Tore Laerdal of Laerdal Foundation gave remarks on behalf of the Survive and Thrive Global Development Alliance (GDA). He informed the audience of the historical launch of the alliance a year ago at the Global Health Summit in Washington by Secretary of State, Hillary Clinton, to harness the resources, expertise, innovation and experience of professional associations, private sector, NGOs and the US government. He highlighted the objectives of the alliance, and the collaboration of the alliance with leadership of ECSA and RCQHC beginning last 2012. He concluded by terming the momentum which has culminated in to the conference, ‘a milestone’. Dr. Grace Miheso of USAID/ EA in her speech noted that a number of African countries are still off target in achieving MDG’s 4 and 5.She further pointed out that to “bend the curve” of the annual rate of reduction of under five deaths, there is need to do things differently, identify how we can rapidly scale up proven and tested interventions, target better the main cause of child deaths and create the right partnerships and alliances to create strategic leverages. She concluded by stating that regional platforms are perfectly placed to maximize the effectiveness of strong political and technical coalitions that can deliver better results greater innovations and lasting impact for the vast majority of those in need. The key note address was made by Prof. Grace Omoni, President CONAMA who stressed the fact that health is a basic human right for mothers, newborns and children and called for greater and sustained efforts to be put in place to scale up interventions that include both Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 9 community and health facility aspects to increase coverage of high-quality services, including family planning, antenatal and postnatal care, and skilled delivery and emergency obstetric care. She concluded by reminding the audience that respectful care is key to quality improvement in maternal and newborn care service delivery in the region. Quality-of-care issues should be viewed from the patient’s perspective and not just from the provider’s. Status of Maternal Health in the ECSA region Prof. Joseph Karanja, President, ECSAOGS highlighted the causes of maternal deaths in the region and how countries are addressing the causes. He summarized that for a difference to be made, governments need to increase financing for maternal health specifically addressing funding for maternal health, establishing national health accounts, putting into place a social safety net for those not able to access services due to lack of funds and ensuring commodities, technologies and health information systems are addressed. He also highlighted that adequate and trained human resources are necessary, a robust HIS and the need for monitoring and evaluation to make sure that we are measuring how we are progressing and sharing best practices Status of Newborn health in the ECSA region Dr. Peter Gisore, EAPA informed participants that out of the two million global neonatal deaths in 2010, four countries in Africa contribute to these deaths, Nigeria, DRC, Ethiopia and Sudan. The Average Annual Reduction Rate (AAR) of newborn deaths have been slowest at only 1.8% with regional disparities coming to the fore with Africa having the slowest AAR rate. Dr. Gisore provided an overview of the high impact interventions to reduce newbprn deaths and highlighted that to make a difference; we need to scale up these interventions with a public health view that must reach the front line workers with the requisite skills and commodities. Dr. Gisore reminded participants that over two thirds of newborn deaths are preventable without intensive care and introduced the concept of 3 by 2 which is that the thee causes of newborn deaths can be addressed by scaling up two key interventions each. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 10 Newborn Survival Solutions 3 X 2 Harnessing potentials of professional health associations to save maternal and newborn lives Jan Chapin, GDA HBB and HMS demonstration To raise awareness of the dignitaries attending the opening ceremony as well as all Forum participants on the HMS and HBB training, the JHPIEGO team facilitated by Peter Johnson demonstrated the use of HMS simulator and the Laerdal Foundation projected a video on utilization of the HBB and HMS simulators. As the end of the session, the Deputy Minister of Health and Social Welfare, United Republic of Tanzania was presented with a full HMS kit by Dr. Lily Kak on behalf of the Survive and Thrive Global Alliance. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 11 Honorable Dr. Seif Rashid, Deputy Minister of Health receives HBB and HMS training materials from Dr. Lily Kak, USAID Experiences in cascading HBB in the ECSA region –Dr. Wamuyu Maina, RCQHC and Alphonse Kalula - ECSA RCQHC and ECSA-HC have since 2011 been rolling out HBB through nurse/midwife training of training in Kenya, Uganda, Burundi, Zambia, Tanzania and Rwanda in collaboration with the respective national nurses/midwifery associations. RCQHC took lead in the HBB trainings in Kenya, Uganda and Burundi whilst ECSA-HC lead the trainings in Zambia, Tanzania and Rwanda Dr. Wamuyu Maina, RCQHC informed participants that, between 2011 and 2013, 332 HBB ToT’s have been trained by RCQHC and ECSA-HC through regional and in-country trainings. Dr. Wamuyu presented how 4 to 9 months after the TOT training, the trainees were followed up to assess their experiences with the cascade training, Post-training knowledge and skills retention using written post-test as well as Observed Structured Clinical Evaluation (OSCE B) and their perceptions regarding the HBB training content suitability, adequacy and adaptability. Follow-up results revealed that through cascade training, the ToT’s had reached over 4,000 health workers using various methods including CME, training in labour ward, on the job training and classroom teaching. In conclusion, both TOTs and cascade trainees demonstrated good knowledge and high skills retention follow-up post tests and OSCE B assessments. The roll of HBB has greatly benefitted from support, leadership and in-house resources from countries, professional associations, councils and structures. The HBB training was appreciated for its simplicity, practicality and comprehensiveness. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 12 Alphonse Kalula, ECSA-HC highlighted that HBB roll out in Tanzania, Rwanda and Zambia were also successful. In Zanzibar, the Reproductive Health Department was able to garner additional support from the African Development Bank (ADB) to roll it out. As evidence of its uptake, HBB in Tanzania mainland is taught in all the EMONC trainings whilst and the nursing and midwifery curriculum review has incorporated the HBB as part of ENC Tanzania, Rwanda and Zambia. Experiences in cascading HMS in Zambia - Martha Ndhlovu, Jhpiego Martha Ndhlovu shared with participants that in May 2013, Jhpiego organized a regional training Zambia for MNH Expert and Master Trainers in HMS using the new training approach that uses Low Dose, High Frequency jobsite practice to improve performance of midwives, nurses, physicians and other maternal newborn frontline health workers. In June 2013, the training was introduced in Mansa District, Zambia. To support the participants, mentorship as well as clinical updates were subsequently provided. The HMS training is being rolled out to national EmONC trainers as well as the Midwifery Association of Zambia. In addition, efforts are being made to raise awareness at different fora. Uganda experience with PPH Management – Dr. Imelda Namagembe - AOGU Dr. Imelda Namagembe, representing the Association of Obstetricians and Gynaecologists of Uganda (AOGU) described the process Uganda went through to integrate AMSTL initiatives in the country. Based on the high maternal deaths due to PPH, a consensus was reached in the country to update the National Reproductive Health Policy Guideline to incorporate AMTSL using Oxytocin as the drug of choice as stated in FIGO/ICM Declaration. Cascade in-service trainings were conducted in the 14 Regional Referral Hospitals of Uganda (Supported by RCQHC) while tutors from midwifery schools and lecturers from University institution were also engaged to incorporate AMTSL in their curricula. Pitocin (preferred drug ) or Misoprostol (in absence of pitocin) was incorporated in the National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights (Latest edition 2012 ) while the Essential Maternal and Newborn Care guidelines with protocols in EmONC have been developed and reviewed to incorporate WHO, ICM/FIGO steps of AMTSL to prevent PPH. AOGU is a key partner of MoH and has contributed to scaling up of AMTSL to prevent PPH and its management, and advocated for the use of Misoprostol for PPH prevention. In conclusion, Dr. Namagemebe reminded participants that we are not yet in the comfort zone and more needs to be done to make a difference. Efforts include the proper dissemination of the job aides on AMTSL with continued on job-training and mentorship, greater partnership needed between the MOH and the professional associations, the need to engage politicians more, development partners to ensure that needed funded are available and put to proper use and strengthened community involvement. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 13 Overview of the draft global “Every Newborn” Action Plan – Lily Kak, USAID Dr. Lily Kak described the Global Newborn Action Plan (GNAP) as a platform for harmonized action by all partners that sets out a clear vision with mortality target, strategic directions, and innovative actions within the continuum of care. It is supported by evidence on epidemiology, effective interventions, delivery mechanisms and accelerators to progress to be published in The Lancet at the time of the launch in May 2014. A harmonized global response will address the slow progress being made in newborn reduction. Dr. Kak presented dramatic successes that have been made in Rwanda, Bangladesh, Nepal and Malawi to demonstrate that even in low resource countries, positive change can happen. The GNAP describes the absolute and relative targets we want to achieve by 2035 then delves into the Strategic Themes to guide the process In conclusion, Dr. Kak described the process remaining before the GNAP will be launched which include the need for continued global, national and regional consultations to stimulate dialogue and action, discuss bottlenecks and solutions, and provide feedback to the ENAP. The outcome will be presented to the WHO Executive Board, with finalization of the Every Newborn Action Plan between October 2013 and May 2014. In May 2014 Every Newborn Action Plan will be launched at World Health Assembly. Overview of Ending Preventable Maternal Death Strategy – Mary Ellen Stanton, USAID. Mary Ellen Stanton highlighted the need to focus on five areas to end preventable maternal and child deaths and unmet need for family planning. These include geography, high burden populations, high impact interventions, an enabling environment and mutual accountability. The need to approach the issue differently through sharpening of plans with focus on implementation was emphasized. It was noted that as we move forward, we should think about addressing the local causes of maternal deaths. In the Sub-Saharan region, coinfections are the major causes of maternal deaths. What stands out is that 40% of the deaths are due to non pregnancy related infections (of which 28% are due to AIDS) compared to 14% from obstetric hemorrhage and 14% hypertension. The need to build on contextual opportunities was stressed for example the urban poor have usually been neglected yet they are beginning to form a large population. In addition, the need to scale up innovations and new technologies was stressed. The issue of respectful maternity care is a neglected priority that needs to be addressed quickly. Regional clinical pre-service and in-service education training initiatives - Gertrude Chipungu, ICAP Country Representative, NEPI Gertrude Chipungu presented on the PEPFAR’s Global Nurse Capacity Building Program which aims to strengthening pre-service nursing and midwifery education for improved family and community health. She informed participants that NEPI largely works in Africa but also has Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 14 programs in Asia and USA. The focus areas are service, research, education and training geared towards addressing MDG 4, 5 and 6. The NEPI education and training component was noted to target both the providers as well as faculty members. In additional educational processes utilized included curriculum development as well as simulation based clinical education. In a bid to ensure sustainability, key strategies implemented are collaborative working with MOH, maximizing regional resources as well as investment in infrastructure and systems. In conclusion, it was noted that NEPI plays a critical role in strengthening health systems through development of nursing and midwifery platform so as to a) Increase quantity, quality and relevance b) Improve retention and distribution c) Strengthen regulatory councils and also d) Strengthen nursing leadership Global evidence on simulation based training - Hege Ersdal, Haydom Hospital Tanzania & Stavanger University Hospital Norway Hege Ersdal outlined that simulation-based training comprised of three key elements namely theoretical background, skills training and acting out a scenario/simulation. Appreciating the importance of these three key elements, she informed participants that a study to determine the impact of one simulation training on simulated performance and clinical management seven months after a one day training was conducted. Results revealed that a one-day simulationbased HBB training improved provider performance however the improvement was not reflected in delivery room management. Systematic re-training of all staff dubbed “low-dose highfrequency” supported by local leaders was thus critical. The low-dose, high-frequency (LDHF) training method offers shorter, more frequent learning opportunities when and where they are convenient for providers. A subsequent assessment of implementation of low-dose highfrequency low-cost simulation training supported by local leaders revealed changes in birth attendants’ clinical practice with reductions in neonatal deaths due to enhanced immediate neonatal resuscitation in the delivery room. Dr. Georgina Msemo, MOHSW Tanzania informed participants that the HBB program in Tanzania comprised of both research and training components. From the research, HBB training was noted to lead to significant reduction on still births, neonatal and perinatal deaths. Using a cascade model approach, over 5000 health providers from health facilities in all levels of care assisting delivery from 4 Regions of the country have been trained. She informed participants that the Tanzanian Health Ministry has made birth asphyxia a national priority and concluded that given the evidence available, HBB should serve as a call to action for other resource‐limited countries striving to meet the MDG. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 15 DAY TWO – 20TH AUGUST 2013 Concurrent training sessions in HBB and HMS The main objective of day two was to train participants in Helping Babies Breathe (HBB) and Helping Mothers Survive (HMS) bleeding after birth which are skills-based and designed for use in resource limited settings. The respective simulation based trainings were conducted in both English and French were facilitated by the trainers from JHPEIGO and AAP as well as those trained as HMS trainers during the pre-forum training of regional masters trainers held on 18th August 2013. Three concurrent trainings were held namely HBB conducted in English and HMS conducted in both English and French. HMS training session for Forum participants – Photo credit Laerdal GH Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 16 HBB training session Photo credit Laerdal GH HBB utilizes a low-cost simulator known as NeoNatalie and paired learning. The emphasis of HBB is on initiating the simple steps of resuscitation namely drying, stimulation, suctioning, and bag-mask ventilation) to get all babies to breathe within the first minute of birth “Golden Minute”. The HMS training package is designed to introduce key knowledge, actions and clinical decisions needed to prevent and manage bleeding after birth . The MamaNatalie birthing simulator is used to demonstrate best clinical practices and provides workers with the realistic simulated experience they need to be comfortable managing postpartum hemorrhage. Both HBB and HMS concurrent trainings were conducted through didactics using graphic flipcharts, workbooks for the trainees followed by simulation using NeoNatalie and MamaNatalie, respectively. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 17 A total of fifty (53) participants were trained on HMS (48 English; 5 French) whilst twenty two (22) participants were trained on HBB. Both pre and post tests were administered during the concurrent trainings. Analysis of the HMS pre and post test scores for participants who did both tests revealed a fair improvement in knowledge and skill following the training as shown in Figures 1 and 2. Percentage PRE- TEST POST TEST Participants HMS English pre and post test scored Pre-Mark Percentage Post- test mark Participants HMS French pre and post test scores Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 18 Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 19 DAY THREE – 21ST AUGUST 2013 Integration of HMS and HBB - JHPIEGO In order to receive maximum impact in delivery of maternal and newborn high impact interventions, integration of key actions in HMS and HBB are vital. With the use skits depicting varied scenarios, the JHPIEGO facilitation team demonstrated to forum participants’ the possible outcomes of clinical practices that choose to implement stand-alone programs and those that integrate HBB and HMS. Overall, it was demonstrated that integration of HBB and HBB by the service providers has immense benefits for both the mothers and babies. Knowledge and skills building in quality improvement in maternal and newborn care RCQHC and URC/ASSIST facilitated a knowledge and skills building session in quality improvement and maternal and newborn care. The purpose of the sessions was to orient forum participants on the definition and process of quality improvement as well as provide them with a hands-on opportunity to work through the quality improvement steps. The session was based on the model of improvement which addresses three key questions namely i) What we are trying to accomplish ii) How we will know that a change is an improvement and iii) What changes can we make that will result in an improvement. The latter includes the implementation of Plan Do Study and Act (PDSA) cycles. Using a pre-designed workbook, participants were led through seven topics that are essential in the conduct of a quality improvement project. Analysis of the Quality improvement pre and post test scores for participants shown in Figure 3, revealed improvement in knowledge following the training. Pre test mark Percentage Post Test mark Participants Quality Improvement pre and post test scores Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 20 Participants from Mauritius and Seychelles confer with a facilitator during the QI training session HBB and HMS certificate award ceremony During the evening session, certificates were awarded to the HBB and HMS trainees. For HMS, over 75 certificates were awarded to both forum participants as well as facilitators. A total of 29 champions, 20 trainers and 26 Master Trainer’s certificates were awarded. Five participants were trained in French. Twenty two (22) participants were awarded HBB certificates. Depending on the training undertaken, participants were provided with a NeoNatalie simulator or MamaNatalie simulator plus a set of the respective training materials to enable them to support HBB or HMS training efforts in their countries. Participants receiving HMS & HBB certificates and training materials Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 21 DAY FOUR – 22ND AUGUST 2013 Technical Updates on High Impact Newborn Interventions Managing Low Birth Weight and Prematurity: Kangaroo Mother Care (KMC) - Prof. Bogale Worku from the Ethiopian Pediatrics Society / AAU Prof. Bogale Worku gave a presentation on Managing Low Birth Weight and Prematurity: Kangaroo Mother Care (KMC). He defined KMC as early prolonged and continuous skin-to-skin contact between a mother and her low birthweight infant, both in hospital and after early discharge, until at least the 40th week of post-natal gestational age, with ideally exclusive breastfeeding and proper follow-up. The 1998 International KMC Conference declaration states that Kangaroo Mother Care is a basic right of the newborn and should be an integral part of management of all newborns in all settings, at all levels of care and in all countries. Prof. Worku discussed the steps to positioning KMC, Kangaroo nutrition, Kangaroo discharge, Kangaroo support, when to start KMC, eligibility criterion for KMC where no major illness present such as sepsis, pneumonia, meningitis, respiratory distress and convulsions, criterion for discharge from KMC unit and guidelines for follow-up after discharge, readmission into the KMC unit and discontinuing KMC. Prof. Worku presented results of a study by Lawn et al on Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications. From the study KMC was found to substantially reduce neonatal mortality amongst preterm babies (birth weight <2000 g) in hospital, and is highly effective in reducing severe morbidity, particularly from infection. However, KMC remains unavailable at-scale in most low-income countries. Promising results from a community based KMC study in Ethiopia were also presented. Chlorhexidine (CHX) for preventing newborn infection - Dr. Nosa Orobaton from Nigeria Targeted States High Impact Project (TSHIP), JSI Dr. Nosa Orobaton made a presentation on Chlorhexidine (CHX) a commonly used antiseptic applied to the umbilical cord stumps of newborns to prevent infection. He began his presentation by describing the status of newborn care in the Africa region highlighting Nigeria’s unchanged NMR over the last two decades (47/1000 in 2003 and 42/1000 in 2008). He listed the major causes of neonatal deaths as pre-term (29%), asphyxia (23%) and infection (25%). Results from cluster randomized controlled trials in Nepal, Bangladesh and India showed a 23% reduction in a pooled analysis equivalent to an overall 18% mortality reduction. Communitybased trials of 4% CHX showed a higher reduction of neonatal mortalities compared to dry cord care with severe omphalitis reduced by 68%. Dr. Orobaton informed the audience that CHX had been found to be safe and effective, low cost, is usable at facility and community, health system compatible, requires low regulation and is scalable. In Sept 2012 WHO recommended 4% CHX Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 22 for cord care. Sokoto State Government in Nigeria was the first to launch a state wide use of CHX together with misoprostol for PPH in March 2013. Helping Mothers Survive (HMS), Helping Babies Breathe (HBB), and Helping Babies Survive (HBS): Common educational methodologies and possibilities for curricular integration. Dr. Sherri Bucher representing the Indiana University School of Medicine and American Academy of Pediatrics gave a presentation on Helping Mothers Survive (HMS), Helping Babies Breathe (HBB), and Helping Babies Survive (HMS): Common educational methodologies and possibilities for curricular integration. She briefly described the programs informing the audience that each program targets a leading cause of maternal and/or newborn death. HMS targets maternal hemorrhage while HBB targets intrapartum asphyxia and HBS targets Infections and complications from prematurity. The three robust programs have shared programmatic goals, similar curriculum development processes, common educational methodologies, validated evaluation components, similar teaching materials, including commonalities of graphical presentation which facilitate presentation of the three curricula as an integrated training package, rigorous educational evaluation and beta-testing and strong support from GDA and other partners. The HBS is global educational evaluation and beta-testing in India and Kenya. Dr. Bucher concluded by informing the Forum that HMS, HBB, and HBS curricula can serve as a package of integrated interventions to support efforts to provide health workers in resourcepoor settings with low-cost, effective, and evidence-based education for prevention of maternal death from hemorrhage and neonatal death from intrapartum asphyxia, infection, and complications from prematurity. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 23 Newborn care panel of experts Birth asphyxia and managing prematurity - Dr. George Little, American Academy of Paediatrics. Dr. George Little gave a presentation on technical updates on high impact newborn innovations with a focus on. In his presentation he discussed HBB which emphasizes the fundamentals of drying, warmth, clearing the airway, stimulation, and positive-pressure ventilation with the Golden Minute highlighting the importance of immediate action. Participants were informed that prematurity is on the rise globally. Babies born preterm face numerous challenges, including difficulty feeding and maintaining body temperature, and can develop serious complications, principally, respiratory distress syndrome (RDS), a condition in which the baby has difficulty breathing because the lungs are not fully developed. Use of antenatal corticosteroids (ACS) reduces the severity and mortality of RDS and should be administered to every pregnant woman who is less than 34 weeks and has a condition that increases the possibility of a preterm delivery. Following a pre-term delivery at home or at a lower level facility after administration of antenatal corticosteroids the mother and baby should be referred and transported to a higher level facility. Twenty four hour skin-to-skin care is encouraged when the baby is less than 2000 grams and stable. When skin-to-skin is not enough (or not available), use of an incubator should be considered. Use of a warmer should be considered when skin-to-skin is not enough (or during special procedures). When a baby cannot feed from the breast or a cup, measure and insert a Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 24 gavage tube. When gavage feeding, calculate and measure breast milk or supplements. Finally when the baby is ready for discharge, plan with the family. Technical Updates on High Impact Maternal Interventions Eclampsia and preeclampsia Suzanne Stalls, vice president of the Department of Global Outreach at the American College of Nurses and midwives opened the session with a technical update on Eclampsia and preeclampsia. The presentation gave an overview of the classification of hypertensive emergencies, systemic effects of the illness, risk factors, and best practices for current prevention, detection and management of pre-eclampsia the condition. For the management of pre-eclampsia she described that WHO recommendations. Interventions for the prevention and management of prematurity Dr. Douglas Lube from the American College of Obstetricians and Gynecologists made a presentation on interventions for the prevention and management of prematurity. The presentation included a definition of the continuum of prevention and management of preterm birth, risk factors, collaborative approach, available interventions that can be adopted, a focus on antenatal steroids and what can be done to advance key best practices. During the presentation it was noted that of the 11 countries with preterm births >15%, 9 are in Africa. It was noted that prevention requires a perinatal collaborative approach with maternal and new born health teams working together and includes prevention of preterm births, management of conditions that lead to preterm births and care of the premature new born. Post partum hemorrhage Dr. Getachew Tefera from the Regional Centre for Quality of Health Care presented on PPH a major cause of maternal morbidity and mortality whose incidence and recurrence rate is estimated at 5% and 10% respectively. In his presentation he mentioned the challenges related to the prevention, early recognition and management of PPH. He noted that addressing PPH requires expanding access to skilled care and, at the same time, extending life-saving interventions along a continuum of care from community to facility. One of the life saving intervention to be extended to the community is the use of Misoprostol for the prevention of PPH in home births and emphasized on the global evidences and the WHO recommendation and urged the participants to advocate for policy change for the use of this intervention at scale. With regards to the facility level interventions, he noted that AMSTL is important in the prevention of PPH. Early recognition of PPH is crucial and involves the routine observation of all women for blood loss through assessment of uterine fundal tone, BP, pulse and measuring blood loss. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 25 Transforming the MNCH services to end preventable MNC deaths: Lessons Learned from the EMTCT drive - Dr Janet Kayita, UNICEF Dr. Janet Kayita gave an insightful presentation which provided an overview of the high burden of HIV attributable maternal and child deaths in ECSA region, progress towards EMTCT, remaining challenges, reflections and opportunities for working together. Highlights included the growing global optimism about ending of the epidemic, demonstration of program feasibility, innovations in service delivery, wide scale implementation, renewed efforts to find a cure and efforts towards virtual elimination of MTCT. The presenter highlighted the trend towards improving MDG 5 in the different ECSA countries with some like Eritrea noted to be on track, others like Ethiopia, Uganda, Rwanda, Eritrea and Malawi making progress, Kenya, Zambia, Burundi and Sudan have made insufficient progress while most countries in southern Africa including South Africa, Swaziland, Namibia and Zimbabwe have made no progress. Dr Kayita highlighted the key advances in the HIV/AIDS management including new and easier diagnostic technologies, simpler once a day treatment regimens and the role of ART in reducing new adult infections. She noted that the New 2013 WHO consolidated ARV guidelines combine guidelines across prevention, diagnosis, treatment for all ages and populations and significant efforts are being made towards adapting service delivery approaches for greater effectiveness such as integrated MCH services. Capacity building of Professional Associations Strengthening professional associations is one of the strategies for increasing access to highquality high-impact interventions in the region accelerating progress in maternal newborn and child health. The session on capacity building for professional associations explored trends, challenges and strategies for institutional strengthening. During the session panelists representing regional and national professional associations were invited to make short presentations on the scope of their associations, obstacles to success and critical success factors. Funding to run effective secretariats and increasing and maintaining their membership base were presented as key challenges by all presenters. Presentations were made by Mr. Paul Chungu - Program Officer Africa network for Associate Clinicians ( ANAC), Prof. Fred Were, Inaugural President - Eastern African Paediatric Association (EAPA) , Ms. Cynthia Chasokela Vice President East Central and Southern Africa College of Nursing (ECSACON),Dr. Henry Wanga - Secretary Kenya Medical Association ( KMA), Prof. Joseph Karanja President East Central and Southern Association of Obstetrical and Gynecological Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 26 Societies (ECSAOGS) and Ms. Angie Fujioka - Technical Advisor Department of Global Outreach , American College of Nurse-Midwives. A confidential poll was conducted to unearth the key challenges to the success of regional and national Health Profession Associations. The top five challenges identified were: Members do not see membership value (55%) Lack of funding for core association staff (43%) Lack of business plan for association revenues (38%) Weak relationships with the ministry of health (34%) Weak communications with members (34%) Lack research capabilities to advance knowledge (30%) Participants in another poll were asked to identify the actions are needed to strengthen HPAs. The top five actions identified were: That membership feels engaged and supported by the organization (56%) The association has a strategic plan that is owned by its members (41%) The association is responsive to member’s needs (40%) The association has diverse sources of funding and sponsorship beyond dues (31%) Strong and respected leadership of the governing body (26%) Establish strong secretariat staff (26%) Participants were randomly assigned into small groups to identify practical actions that have potential to accomplish the top five strategies for strong professional associations. Recommended actions for stronger health professional associations were grouped into actions to be accomplished in the next 9 days, 9 weeks and 9 months. A Summary of the recommendations are as follows; Respectful maternity care – Mary Ellen Stanton, USAID This session objective was to familiarized participants on the topic of respectful maternity care (RMC), the issues, the evidence and the work being done to address the issue. It also provided the RMC perspective by the health care provider and recipient of health care with a discussion how can begin to discuss actions for advocating respectful maternity care at the regional and national professional association level. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 27 Respectful Maternity Care panels of experts Angie Fujioka, ACNM provided an overview of RMC both globally and in Africa. She highlighted that the many perspectives on RMC males it difficult to neatly define and manage it because of various reasons including the many definitions of abuse and disrespect, the various contributory factors and the reality that in many instances it’s perception based. Ms. Fujioka gave some global efforts to address RMC. Brazil was able to initiate an RMC movement that resulted in valuable maternity policy changes that included incorporation of RMC principles into pre-service and inservice training, inclusion into antenatal and birth policy, allowing women to have a birth companion of their choice and having model centers as examples of how it can be done. She highlighted some do the finding of the TRAction project that conducted a landscape analysis on D&A in 2010 which aimed to review the evidence of D&A, the scope and contributing factors of the problem, and the impact and promising intervention approaches. The overall goal was to stimulate dialogue and implementation research on RMC. The session was finalized with a WRA video that was developed by the White Ribbon Alliance to create awareness and advocate for support. Ms. Fujioka also introduced participants to available resource materials on RMC. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 28 Lilian Mutea, USAID and Michael Irira, MOH Tanzania presented the country’s experience with the TRAction project which highlighted the prevalence of D&A, stakeholder involvement and steps being taken to address D&A. One of the highlights was the impact of free maternity care. A panel discussion was facilitated which garnered perspectives from various health care providers on RMC. The topic generated very heated and critical discussions. To conclude the session, Margaret Nyandoro from Zimbabwe representing the MNH advocates in the region summarized the session with a Call for Action for all participants to put their joint resources to address RMC as an issue that requires commitment by all to make a difference. DAY FIVE – 23RD AUGUST 2013 Experiences with developing/establishing a community of practice in MNCH - Dr. Jorge Hermida, URC/ASSIST project Dr. Jorge Hermida defined a community of practice as group of individuals/health care workers working on a common effort and want to connect with other people either face to face or virtually so as to share knowledge and experiences. Using this definition as a foundation, Dr. Hermida shared experiences from Latin America on a community of practice to help root the implementation and sustainability of Kangaroo Mother Care. He explained that in addition to face to face interaction, personnel trained to implement Kangaroo Mother Care services in the five countries of El Salvador, Nicaragua, Guatemala, Honduras, Ecuador benefit from a webbased platform. The online platform hosts resource materials; has a discussion forum in which members can post their comments as well as “Ask the expert”. In addition, through the web, members can receive news plus participate in structured web-based seminars and e-learning courses. Forum participants were taken through a visual walk of the KMC community of practice web page. On-line engagement of health practitioners through the IBP Initiative – Dr. Odongo Odiyo, ECSA On-line engagement of health practitioners through the IBP Initiative was described by Dr. Odongo Odiyo from the ECSA-Health Community. He outlined the key considerations for the formation of a community of practice and informed participants that ECSA-HC joined the IBP gateway in 201O and their website was connected to that of ECSA. An initial training on Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 29 management of the knowledge gateway with ECSA was provided in 2011 and later extended to other regional organizations such as ESAMI and EACE. To manage the gateway an administrator was appointed before members of the discussion network groups were invited to participate. Dr. Odongo highlighted community MNCH as well as journalist network on management of PPH as some of the existing communities of practice at ECSA-HC. In conclusion he emphasized the need for adequate preparations and planning before establishment of a community of practice, mobilization of resources to facilitate the process and appointment of a moderator for each discussion topic. Introduction to the implementation framework for Survive and Thrive Alliance – Lily Kak, GDA Dr. Lily Kak made a presentation of the Survive and Thrive Alliance describing who the key partners are and what the alliance wants to achieve. The goal of the Survive and Thrive Alliance is to increase utilization and impact of high-quality. High impact maternal, newborn and child health interventions in health facilities. The presentation provided an overview of the three objectives and strategies to be used to enable this goal be achieved. Harnessing the potential of professional associations is one of the three objectives of the alliance and this is through mentoring, training, supporting the development and implementation of guidelines, multi-disciplinary role-modeling, twinning of professional associations and the establishment of a community of practice. The presentation ended with suggestions how the alliance would work in the region with the framework below as the guide. This session therefore provided a good background for countries to then develop their workplans. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 30 Regional and Country level action planning The last session of the forum was the development of regional and country level action plans to support the integration of technical updates learned into country policies, curricula. ECSA-HC, RCQHC gave technical backing to the regional groups, and Survive & Thrive Alliance gave technical support to the countries. From the action plans developed (Appendix 3), RCQHC and ECSA-HC identified the two regional organizations could potentially provide technical support the following: Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 31 1. Advocacy for uptake of high impact MNCH interventions and innovations. It is envisioned that the professional associations would take the lead using the position to advocate for these with the MOH, teaching institutions, private sector, the public and other stakeholders. 2. Capacity building of clinical competencies of health workers (community, facility) and professional associations. The initial focus as expressed by countries will be to scale up HBB and HMS training in the countries. Other priorities will be identified later 3. Institutionalization of quality improvement (capacity building, incorporation in guidelines & standard operating procedures (SoP’s) 4. Establish/Strengthen Community of Practice (CoP’s) for MNCH as well as sharing experiences, lessons learnt & best practices in governance, management & leadership among professional associations 5. Strengthen capacity of professional associations in strategic planning, governance leadership and management, resource mobilization amongst others Closing ceremony Dr. Grace Miheso Senior Maternal and Child Health Advisor, USAID/EA thanked all participants for their active participation and reminded them about the call to action and the need to bend the curve. Dr. Lily Kak representing GDA partners thanked the forum organizers ECSA-HC, RCQHC & USAID EA. She noted that that the forum has created a new platform and more networks which she hoped would all work together to reduce maternal and newborn mortality. She appreciated the creation of a community of practice which would provide a way of sharing best practices and hoped that all professional associations will grow much stronger to drive the agenda forward. The new approach of training using simulators was highly appreciated. In addition, she appreciated the discussion on disrespect and abuse mentioned that all teams can make a difference in providing respectful maternity care Dr. Wamuyu Maina, Deputy Director of RCQHC thanked all the organizers as well as participants for the resilience shown by withstanding long hours of deliberations. She expressed hope that what was learnt will translate into the knowledge and skills to bring behavior change. She applauded all the new trainers and champions had been graduated from the HMS training and reiterated that RCQHC is committed to work with all teams in their planned activities to meet the MDG goals. A participant representative thanked the forum organizers and noted that they were privileged to get the technical updates, skills and training equipment. On behalf of the participants, a promise was made to use the knowledge skills obtained to meet their country challenges in a bid to address child mortality and morbidity. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 32 Dr. Josephine Kibaru, Director General ECSA Health Community, appreciated everyone’s patience, appreciated their active participation shown during the meeting. She congratulated all the trainers and master trainers who did courses in HBB and HMS. She expressed the need to tap into the role of professional associations, to forge a lot more collaboration since there are many untapped resources. She noted that there is room for north to south collaboration in terms of improving quality of care in the region and hoped that the work plans developed will be operationalized. The Honorable Minister, Dr. Jessica Eriyo thanked all participants and hoped that the officers who graduated into trainers and master trainers will spearhead the agenda. She noted that professionalism is important in attaining sustainable development and also important for sustaining life. She mentioned that medical practitioners are more co-creators with God they usher life to the world hence need to make sure that during delivery mother and baby are safe. She reminded teams present that Africa is still lagging behind as far as the MDGs are concerned and some of the interventions required are simple and doable. She concluded by congratulating Dr. Margaret Mungherera from Uganda at being elected as the President World Medical Association and requested all associations to use her to reach out to more partners to advocate for the professionals. Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 33 APPENDICES APPENDIX 1. FORUM AGENDA Regional Maternal and Newborn Care Forum August 19 - 23th August 2013 Snowcrest Hotel, Arusha, Tanzania Agenda Objectives of the meeting 5. To strengthen the capacity of Regional Professional Associations to address Maternal, Newborn and Child Health issues 6. To orient participants on quality improvement processes 7. To strengthen the organizational capacity of Professional Associations 8. To deliberate on the formation and coordination of an African maternal and newborn care community of practice Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 34 Master of Ceremony – Stephen Muleshe, ECSA Activity Responsible person Time Day 1: Monday 19th August 2013 Time 8.30am – 11.00am Moderator: Odongo Odiyo - ECSA-HC Venue, Pangani Activity Presenter Opening ceremony PS MOHSW Tanzania Welcome remarks Wamuyu Maina, Deputy Director RCQHC Tore Laerdal, Survive & Thrive Alliance Grace Miheso, USAID/East Africa Josephine Kibaru, Director General ECSA-HC Official Opening Dr. Seif S. Rashid, Deputy Minister for Health and Social Welfare, Tanzania Key note address Prof. Grace Omoni, President CONAMA Status of Maternal health in ECSA region Prof. Joseph Karanja, President, ECSAOG Status of Newborn Health in ECSA region Peter Gisore, EAPA Harnessing potentials of professional health associations to save maternal and newborn lives Jan Chapin, GDA Video demonstration of HBB and HMS Ida Neuman, Laerdal Global Health Group photo 11.00am– 11.30am Health Break Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 35 11.30am-1.30pm Moderator:: Grace Miheso - USAID/EA Updates on maternal and newborn health interventions and best practices Venue: PANGANI Experiences in cascading HBB in Kenya, Uganda and Burundi Wamuyu Maina, RCQHC Experiences in cascading HBB in Zambia, Tanzania and Rwanda Alphonse Kalula, ECSA-HC Uganda experiences with PPH management Imelda Namagembe , Secretary, Association of Obstetricians & Gynecologists of Uganda (AOGU) Overview of the draft global "Every Newborn” Action Plan." Lily Kak, USAID Overview of Ending Preventable Maternal Death Strategy Mary Ellen Stanton, USAID 4.15 – 4.30pm Discussion and Recommendations on way forward Lunch Break Moderator: Daniel Tumwine, RCQHC Venue: PANGANI Clinical education training initiatives Regional training initiatives for clinical Gertrude Chipungu, ICAP Country education in pre-service and in-service Representative, NEPI setting MEPI, TBD Discussion Country Poster Gallery Countries will showcase unique innovations, approaches, and interventions that reduce maternal and newborn mortality. Tea Break 4.30 – 5.15pm 1.30pm-2.30pm 2.30pm-3.15pm 3.15 – 4.15pm Global evidence on simulation based training, with examples from HBB in Tanzania and HMS in Zambia Discussion Hege Ersdal, Haydom Hospital Tanzania & Stavanger University Hospital Norway, Estomih Mduma, Haydom Hospital Tanzania Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 36 5.15pm-6.30pm 7.00pm – 9.00pm Georgina Msemo, MOHFW Tanzania Martha Ndhlovu, Jhpiego, Zambia Country Poster Gallery and Facilitators’ meeting Welcome Reception Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 37 Day 2: Tuesday 20th August 2013 10:30am-11.00am 11.00am-1.00pm Moderator: Wamuyu Maina, RCQHC Venue: PANGANI Activity Presenter Recap of day 1 Rapporteur Concurrent Training sessions: 1. Helping Mothers Survive Peter Johnson, Jhpiego (English - Pangani) Tore Laerdal, Ida Naeuman, LGH (French – Rafiji) Angie Fujioka, Suzanne Stalls, ACNM 2. Helping Babies Breathe Doug Laube, ACOG (Ujiji) George Little, Sherri Bucher, AAP Health Break Continue Training sessions As above 1.00pm-2.00pm 2.00pm-4.30pm Lunch Break Continue Training sessions 4.30pm-5.00pm 5:00pm-7:30pm Tea Break and facilitators’ meeting Concurrent sessions Moderator: Angie Fujioka, ACNM Time 8.30am – 8.45am 8.45am-10:30am 1. Review and discussion of; a. New GDA training materials: HBS, Preterm b. PA capacity building materials and plans Moderator: Mary Ellen Stanton, USAID HMS:AMSTL and HBB: Resuscitation – What, How, When, Should we - integrate new training approached within the context of existing training programs As above Venue: UJIJI George Little, AAP Doug Laube, ACOG Angie Fujioka, ACNM Suzanne Stalls, ACNM Jan Chapin ACOG Venue: PANGANI Panel discussion of country experiences Alan Govoga, MOPHS, Kenya Nancy Kidula, KOGS Georgina Msemo, MOHFW Tanzania Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 38 Gertrude Chipungu, ICAP Country Representative, NEPI Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 39 Day 3: Wednesday 21th August 2013 Time 8.30am-8.45am 8.45am-11.00am 11:00am -11:30 am 11:30am- 1:00 pm 1:00pm – 2:00pm 2:00pm – 4:30pm 4.30pm- 5.00pm 5:00pm-7.30pm Moderator: Stephen Muleshe, ECSA – HC Venue: PANGANI Activity Presenter Recap of day 2 Integration of HMS and HBB: George Little, AAP demonstration and practice Peter Johnson, Jhpiego Health Break Knowledge and skills building: Wamuyu Maina, Getachew Tefera, Quality Improvement in maternal and Christine Omondi, RCQHC newborn care Jorge Hermida, Paul Isabirye, URC/ASSIST Lunch Moderator: Angie Fujioka, ACNM Venue: PANGANI Knowledge and skills building Wamuyu Maina, Getachew Tefera, (continued): Christine Omondi, RCQHC Quality Improvement in maternal and Jorge Hermida, Paul Isabirye, newborn care URC/ASSIST Tea Break and facilitators’ meeting Moderator: Christine Omondi, RCQHC Venue, Pangani Evening session: Completion of course for certification George Little, AAP as trainers of HBB and HMS Tore Laerdal, LGH Peter Johnson, Jhpiego Sherie Bucher, Day 4: Thursday 22 August 2013 Time 8.30am-8.45am 8.45- 10.45am Moderator: Nancy Kidula, KOGS Presenter Activity Recap of day 3 Technical Updates on High Impact Maternal Interventions Pre-eclampsia/eclampsia Preterm birth Discussion PPH Venue: PANGANI Suzanne Stalls, ACNM Doug Laube, ACOG Getachew Tefera, RCQHC Janet Kayita, UNICEF Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 40 10:45am-11.05am 11.05am- 1.00pm 1:00pm-2:00pm 2:00pm-4:30pm 4.30pm-5.00pm 5:00pm-7:30pm Transforming MNCH services to save the lives of women, newborns, children: Lessons Learned from the eMTCT drive" Discussion Health Break Technical Updates on High Impact Newborn Interventions Perspectives on status of newborn interventions and comment on Birth Asphyxia: Helping Babies Breathe and on Managing Prematurity Managing Low Birth Weight and Prematurity: Kangaroo Mother Care Managing neonatal infections : Chlorhexidine Helping Mothers Survive, Helping Babies Breathe, and Helping Babies Survive: Educational methodologies and possibilities for curricula integration" Discussion Lunch Moderator: Christine Omondi, RCQHC Capacity Building of Professional Associations Welcome remarks Overview Panel Discussion Small group work Next steps Tea Break and facilitators’ meeting Moderator: Grace Miheso, USAID/EA Evening session: Respectful maternity care: Overview presentation George A. Little, AAP Bogale Worku, Ethiopian Pediatrics Society Maishanu Abubakar, JSI/TSHIP, Nigeria Sherri Bucher, AAP Venue: PANGANI Odongo Odiyo, ECSA Angie Fujioka, ACNM Fred Were; EAPA, Paul Chunga, ANAC; Suzanne Stalls, ACNM, TBD Jim Rice, ASH Angie Fujioka, ACNM Venue: PANGANI Angie Fujioka - ACNM Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 41 Kenya & Tanzania experiences Panel Discussion Discussion Lilian Mutea, USAID/Kenya Michael Irira, MOH, Tanga District Charity Ndwiga , Pop Council, Michael Irira, MOH, Tanga District Mary Ellen Stanton, USAID Dr. Joseph Karanja, ECSAOG Margaret Nyandoro, MOH Zimbabwe Day 5: Friday 23th August 2013 Time 8.30am-9.00am 9.00am-9.30am Moderator: Getachew Tefera, RCQHC Venue: PANGANI Activity Presenter Recap of day 4 Experiences with developing/establishing a community of practice in MNCH A regional experience in Kangaroo Mother Jorge Hermida, URC/ASSIST Care from Latin America On-line engagement of health Odongo Odiyo, ECSA-HC Lily Kak, USAID Survive and Thrive Alliance Angie Fujioka, ACNM Doug Laube, ACOG George Little, AAP Susanne Stall, ACNM RCQHC, ECSA-HC, Survive & Thrive Alliance practitioners through the` Implementing Best Practice Initiative 9.30am-10.30am 10.30am-11.00am Introduction to the implementation framework for Survive and Thrive Alliance Interactive discussion on modalities of support from the Survive and Thrive Alliance Group work - Regional and Country level action planning Country plans to integrate technical updates learned into country policies, curricula, etc. Technical support required from ECSA, RCQHC, and Survive & Thrive Alliance to support country plans Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 42 11.00am-11.30am 11.30am-1.00pm 1.00pm-2.00pm 2.00pm-3.00pm 3.00pm-3.30pm Health Break Group work ECSA-HC, RCQHC Lunch Break Moderator: Stephen Muleshe, ECSA – HC Venue: PANGANI Report back and consensus building and ECSA-HC, RCQHC recommendations Closing ceremony PS MOHSW Tanzania Closing remarks USAID Lily Kak, GDA Partners Wamuyu Maina, Deputy Director RCQHC Josephine Kibaru, Director General, ECSA-HC Ministry of Health Tanzania Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 43 APPENDIX 2. LIST OF PARTICIPANTS No. Country Institution Designation Telephone Email 1. Dr. Mabel K.M. Magowe Botswana Lecturer Botwana 3. Dr. Fabrice Kakunze Burundi +2673554669 +26776192326 +2673953840 +26773464640 +25779988503 Tel: +2572222838 [email protected] 2. Mr. Lebogang Phillip 4. Nzirubusa Pascal Burundi Nurse +25777795954 [email protected] 5. Ndayishimiye M. Louise Burundi University of Botswana P.O. Box 41324 Gaborone, Botswana Botswana Nurses Union P.O. Box 126, Gaborone, Ministry of Health National Reproductive Health Programme, Bujumbura, National Institute of Public Health Bujumbura Ministry of Health, Bujumbura, +25779698647 6. Dr. Bazikamwe Sylvestre Burundi ndayishimiye.marielouise@y ahoo.fr [email protected] 7. Dr. Niyungeko Deogratias Burundi Clinic Officer (Anesthesiste) Obstetrician/Gynaecol ogyst Focal Point EMNOC President Burundian +25722275333 Cell:+25777750602 [email protected] [email protected] 8. Bukuru Hetene Burundi Paediatrician +25777777464 [email protected] 9. Prof Bogale Worku Ethiopia Executive Director/Facilitator [email protected] 10. Mrs. Alemnesh Tekleberham 11. Mrs. Abigail A. Kyei Ethiopia +251116451434, +251911202423 +251115502124 Mob: +251911156263 +233246339241 Ghana Member of Burundian Association of Obs/Gyn,UTH CHU Kamenge – Bujumbura, BP 2210 Paediatric Association Ministry of High Education Faculty of Medicine P.O. Box 1020 Bujumbura Member of Burundi Pediatrician Association University of Burundi Bujumbura Ethiopian Pediatrics Society, Addis Ababa Jhpiego Addis Ababa, Ethiopia Bole Sub city International Confederation of Midwives (ICM), P.M.B L19 Legon Post Office Accra President In charge of Clinic International Midwife Advisor +25722231708+2577 5807827 [email protected] [email protected] alemnesh.tekleberham@jhpi ego.org [email protected] 12. Mr. Allan Govoga Agala Kenya 13. Mr. Peter Sewe Kenya 14. Dorcas Wandera Kenya 15. Dr Henry O.J. Wanga Kenya 16. Roselyn Koech Kenya 17. Jeremiah Mainah Kenya 18. Prof. Joseph G. Karanja Kenya 19. Prof Grace M. Omoni Kenya 20. Dr David Githanga Kenya 21. Fredrick Were Kenya 22. Dr Janet Kayita Kenya 23. Dr. Peter Gisore Kenya 24. Mrs. Rosemary Kamunya Kenya 25. Mrs. Charity Ndwiga Kenya 26. Dr Nancy Kidula Kenya 27. Lilian Mutea Kenya Ministry of Health P.O. Box 43319 Ministry of Health, P.O. Box 9595 Nairobi, Kenya Ministry of Health P.O. Box 30016-00100 Nairobi Kenya Medical Association P.O. Box 1933 KNH 00202 Nairobi Nursing Council of Kenya P.O. Box 20056-00200, Nairobi, Kenya National Nurses Association of Kenya, P.O. Box 49422-00100, GPO University of Nairobi & KOGS P.O. Box 56772-00200,Nairobi University of Nairobi P.O. Box 19676-00202 KNH Nairobi, Kenya Paediatric Association P.O. Box 19601-00202 Nairobi Eastern African Paediatric Association P.O. Box 20956, 0020C, Nairobi UNICEF ESARO P.O. Box 44145 EAPA P.O. Box 5861 Eldoret Jhpiego P.O. Box 188, Nyeri, Kenya Population Council P.O. Box 17643 Nairobi P.O. Box 47637-00100 Nairobi USAID Kenya Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Clinical Officer +254722235670 Chairman Clinical Officers Council (K) Deputy Chief Clinical Officer +254725705144 +254724546139 +254722233265 Hon. National Secretary +254722275695 +254722892826 [email protected] [email protected] Education Officer +254722269489 [email protected] Chairman +25420272833+2547 27830044/725770087 +254722 513881 [email protected] [email protected] [email protected] [email protected] [email protected] President of ECSAOGS CONAMA President President Senior Health Specialist Paediatrician Senior Regional Technical Advisor Programme Officer Ob/Gyn Consultant +254202711250 +254727466460 [email protected] [email protected] [email protected] [email protected] +254722524359 Cell: +254711524359 +254202718877, +254733708770 +2547624536 Mob: +254700871181 +254725619549 [email protected] +254722963213 [email protected] m [email protected] +2542713480 +254722395641 +254202718373 Mob: +254733614081 Tel: 8622000 Page 45 [email protected] [email protected] [email protected] [email protected] [email protected] 28. Dr. Grace Miheso Kenya USAID East Africa 29. Ann Ojijo 30. Mrs. Cecilia Khachane Kenya Lesotho USAID- Kenya Ministry of Health, P.O. Box 514 Maseru, Lesotho, Health Headquarters 31. Mrs. Makhotso H. Tsotetsi Lesotho 32. Nancy Masache Malawi 33. Mrs. Twambilire Phiri Malawi 34. Mrs. Angelina Chilabade Malawi 35. Gertrude Chipungu Malawi 36. Mr. Tiyamike Harold Goliati Malawi 37. Prof. Frank Taulo Malawi Ministry of Health P.O. Box 514 Maseru, 100, Health Quarters Ministry of Health P.O. Box 30377 Lilongwe, Malawi Ministry of Health P.O. Box 30377 Lilongwe, Malawi Malawi College of Health Sciences, Private Bag 396 Blantyre, Malawi ICAP – Columbia University P.O. Box 31604 Lilongwe, Malawi National Organisation of Nurses and Midwives of Malawi P.O. Box 30393,Capital City, Lilongwe 3 College of Medicine, University of Maboo P/Bag 360 Blantyre 3 Malawi 38. Dr. Hasan Miyan Abdool Majid 39. Maudhoo Madan Mohan Karnautr Mauritius 40. Mrs. Ramguttee Rajcoomaree 41. Mr. Bagooaduth Kallooa Mauritius Mauritius Mauritius Flacq Regional Hospital, Ministry of Health Mauritius Ministry of Health, Mauritius Nursing Association 159, Royal Road, Beau Bassin, Mauritius 159, Royal Road, Beau Bassin Mauritius Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Regional MCH Specialist Tel: 8622000 [email protected] Tel: 8622000 +26622226495 +26658859741 [email protected] [email protected] +2662226458 +26663278160 [email protected] Principal Reproductive Health Officer Chief Reproductive Health Officer +265884579365 [email protected] +265999953309 [email protected] Principal Lecturer +265999784687 [email protected] +2651772615 +265888550047 +2651771210 +265881957797/1957 797 265991332626 [email protected] +2302548652 +2307127134 +2304648031+23046 44875 +2302532169 +2304649406 +2309723855 +2304649406 +2307774270 [email protected] Community Based Health Services Manager Family Planning Manager Vice President President of Association of Obs/Gyn Consultant in Charge, Paediatric Unit, Consultant in Charge Obstetrician/Gynaecol ogy Treasurer of Nursing Association – CNR President Mauritius Nursing Association Page 46 [email protected] [email protected] [email protected] [email protected] [email protected] 42. Dr. Maishanu Abubakar Nigeria 43. Elsa Soyland Norway 44. Mrs. Ida Neuman Norway USAID/TSHIP Bkk 14 Shchkangiwa Secretariat Sokoto, Norway,Laerdal Global Health 4029 stawanger Norway Laerdal Global 45. Tore Laerdal 46. Dr. Beata Mukarugwiro Norway Rwanda LaerdalGlobal Health Jhpiego, Rwanda P.O. Box 1680 47. Dr. Bagambe Patrick Rwanda Ministry of Health 48. Dr. Orikiiriza Judy 49. Kanimba Justine 50. Mr. Jean D. Gasherebuka Rwanda Rwanda Rwanda 51. Mr. Andre Gitembagara Rwanda 52. Dr. Lisine Tuyisenge Rwanda 53. Mrs. Jeannine Marguerite-Marie marimba 54. Mrs. Marie Antonette Hoarau Seychelles 55. Mrs. Deliwe Nyathikazi 56. Mrs. Phumzile S. P. Mabuza Mob: +2348035928769 +4799793686 [email protected] Global Program manager Managing Director MNH Senior Technician, Advisor Ag. RSGO (Obs/Gyn) +49280345 [email protected] +250788302804 [email protected] Beata.mukarugwiro@jhpiego .org [email protected] Rwanda Military Hospital P.O. Box 3377 Ministry of Health Rwanda Allied Health Professions Council/Federation, Kigali Rwanda Nurses and Midwives Association P.O. Box 5406 Kigali, Rwanda Pediatric Association Kigali Nurses Association of the Republic of Seychelles, Mahe, Doctor – Pediatrician Chairman +250783511391 +250788597827 +250788554526 [email protected] [email protected] [email protected] President 250788355245 Seychelles Nursing Association Republic of Seychelles (NARS), SAINT LOUIS MAHE South Africa Swaziland ICM, 18 College Street Polokwane Ministry of Health,P.O. Box 5 Mbabane, Swaziland Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania +250788434986 [email protected] [email protected] +250788411764 [email protected] Nurse Midwife 438800/4388267 2521454 [email protected] Nursing/Midwife (NARS Committee Member, Director +2484388017 +2482723044 [email protected] [email protected] +27152936037 +27834126667 +2684050003 +26876134503 [email protected] Sexual Reproductive/Matern al and Newborn Manager Page 47 [email protected] m 57. Mrs. Zandile Masangane Swaziland Ministry of Health,P.O. Box 559 Mbabane, Swaziland 58. Bheki Mamba Swaziland 59. Dr Ruth Mkhonta Swaziland 60. Hon. Dr Seif S. Rashid (MP) Tanzania Swaziland Nurses Union P.O. Box 2031,Manzini, National Representative ECSACON, University of Swaziland,P.O. Box 369 Mbabane, Ministry of Health and Social Welfare, P.O. Box 9083 Dar es salaam, Tanzania 61. Mr. Martin Elias Tanzania 62. Mrs. Lucy Robby Issarow Tanzania 63. Dr. Georgina Msemo Tanzania 64. Dr. Michael E. Irira Tanzania 65. Dr. Jorgen Linde 66. Dr. Primus Saidia Tanzania Tanzania 67. Mr. Paul Magesa Tanzania 68. Dr. Fadhlun M Alwy Tanzania 69. Mrs. Gaudiosa Tibaijuka Tanzania 70. Dr. Miriam Kombe 71. Dr. Raz Stevenson 72. Dr. Hege Ersdal Ministry of Health and Social Welfare,P.O. Box 9083 Dar Es Salaam, Tanzania Ministry of Health and Social Welfare, P.O. Box 9083 Dar es Salaam, Tanzania Ministry of Health and Social Welfare, P.O. Box 9083 Dar es Salaam Korogwe District Hospital P.O. Box 571,Korogwe, Tanga, Tanzania 900 private Bag, Mbulu, Tanzania P.O. Box 701,Dar es Salaam Tanzania National Nurses Association (TANNA) P.O. Box 11836,Dar es Salaam, Dar es Salaam ASRH Focal Person (Programm Officer, SRHU) President +26824049857 +26876075531 [email protected] om +26876124086 [email protected] Lecturer +26825170731 +26876427611 Fax: +264246241 [email protected] Deputy Minister +255767100900 Private Secretary to Deputy Minister for Health Principal Nursing Officer Newborn and Child Health Program Manager Medical Officer HBB Trainer,Laerdal President,Medical Association of Tanzania (MAT) President +255713248773 [email protected] +255754094470/7883 90043 +255754261126 [email protected] +2557640828 +784818723 +255785333614 +255754809742 [email protected] +255763394965 +255713599593 +255715299560 [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] Sr Technical Manager +255754695621 Tanzania Tanzania Jhpiego P.O. Box 9170 Dar es Salaam USAID – Tanzania USAID – Tanzania MNCH Advisor Senior MCH Advisor +255764105020 +255789788102 Gaudiosa.Tibaijuka@jhpiego. org [email protected] [email protected] Tanzania Haydom Hospital, Tanzania Researcher +4799647822 [email protected] Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 48 4022 stavangir, Narway Haydom Hospital, Mbulu, 73. Mrs. Karoline Linale Tanzania 74. Estomih Mduma Tanzania 75. Mr. Marc Nkwame Tanzania 76. Joseph Ngilisho Tanzania 77. Mwanaidi Mkwizu Tanzania 78. Bridget Mung’atia Tanzania EAC Secretariat P.O. Box 1096 Arusha 79. Dr.Josephine KibaruMbae 80. Ms.Dorothy Namuchimba Tanzania 81. Dr. Odongo Odiyo Tanzania 82. Mr. Alphonce Kalula Tanzania 83. Ann Masese Tanzania 84. Mr. Arthur Rutaroh Tanzania 85. Dr. Stephen Muleshe Tanzania East, Central and Southern Africa Health Community P.O. Box 1009 Arusha FSN East, Central and Southern Africa Health Community P.O. Box 1009 Arusha, Tanzania FRHP East, Central and Southern Africa Health Community P.O. Box 1009 Arusha, ECSACON East, Central and Southern Africa Health Community P.O. Box 1009 Arusha East, Central and Southern Africa Health Community P.O. Box 1009 Arusha, RIA East, Central and Southern Africa Health Community P.O. Box 1009, Arusha, HIV/AIDS, TB & ID Tanzania Haydom Lutheran Hospital P.O. Box 9041 Mbulu, Manyara Media Daily News (TSN) P.O. Box 577 Arusha The East African Newspaper P.O. Box 3153 Arusha, Tanzania ITV/Radio One Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Program Implementation Advisor Research Manager +255783552616 [email protected] +255755876879 [email protected] +255784818463 [email protected] Journalist +255755250300 [email protected] Journalist +255272546102 Cell: +255754381089 +255768420937 [email protected] +2552725449365 [email protected] Manager +2552725449365 [email protected] Manager +2552725449365 [email protected] Ag. Manager, HRH&CB/ SPO +2552725449365 Mob: +255656185023 [email protected] Adolescent Sexual and Reproductive Health Officer Director General Programme Officer +2552725449365 [email protected] and [email protected] [email protected] Manager +2552725449365, [email protected] Manager +2552725449365 [email protected] Page 49 86. Victor Nestory Tanzania 87. Agnes Nyangi Tanzania 88. Christine Mhanusi Tanzania 89. Darcy Njenga Tanzania 90. Dr. Imelda Namagembe Tanzania 91. Dr. Tusingwire Collins Uganda 92. Dr. Nyabwana Denson Uganda 93. Dr Kiggundu Charles Uganda 94. Namugosa Annet Caara Uganda 95. Isabirye Charles Uganda 96. Mpiima Patrick Uganda 97. Ezaga Juliet Uganda 98. Dr. Arthur Mpimbaza Uganda 99. Dr. Jolly Nankunda Uganda East, Central and Southern Africa Health Community P.O. Box 1009 Arusha East, Central and Southern Africa Health Community P.O. Box 1009 Arusha, East, Central and Southern Africa Health Community P.O. Box 1009 Arusha East, Central and Southern Africa Health Community P.O. Box 1009 Arusha East, Central and Southern Africa Health Community P.O. Box 1009 Arusha Mulago Hospital & AOGU P.O. Box 7051 Kampala, Uganda Reproductive Health ,Ministry of Health ,P.O. Box 7272 Kampala, Uganda Uganda Medical Association P.O. Box 2243 Kampala Uganda Mulago Hospital,P.O. Box 7051 Kampala, Uganda Integrated Medical Clinical Officers Association, P.O. Box 7218,Kampala, Uganda The Integrated Medical Clinical Officers Association P.O. Box 22036,Kampala Allied Health Professionals Council Ministry of Health Uganda P.O. Box 7272 Kampala Uganda Nurses and Midwives Council (MOH), P.O. Box 4046, Kampala, Uganda Paediatric Association P.O. Box 7072 Kampala Uganda Paediatric Association P.O. Box 7072 Kampala Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania +2552725449365 [email protected] Admin Assistant +2552725449365 [email protected] Admin Assistant +2552725449365 [email protected] Administrative and Accounts Officer +2552725449365 [email protected] Consultant Obs/Gyn & ED AOGU Ag. ACHS- +256772404902 [email protected] om [email protected] Assistant Commissioner Health/Treasurer Gynaecologist,Vice President, AOGU Uganda/Senior Clinical Officer +256777048832 +256786507896/7567 33720 +256414533451 +256772642841 +256772560152 [email protected] President General +256414235525 +256772893011 +256772503126 [email protected] +256431229037 +256772452604 +256712846913 [email protected] +256772503234 [email protected] Registrar Nurse (T/O) Paediatrician +256774644929 Page 50 [email protected] [email protected] [email protected] [email protected] 100. Dr. Isabirye Paul Uganda 101. Dr. Getachew Tefera Belihu 102. Dr. Daniel Tumwine Uganda 103. Dr.Gakenia Wamuyu Maina Uganda 104. Ndagire Kisakye Gloria 105. Christine Omondi Uganda 106. Jascent Tusubiira Uganda 107. Dr. Grace Baunahn UK 108. Suzanne Stalls USA 109. Angie Fujioka USA 110. Dr. Jorge Hermida USA 111. Prof. George A. Little USA Uganda Uganda 112. Janet Chapin RN MPH USA 113. USA Dr. James Rice URC/USAID – ASSIST Project Kampala RCQHC P.O. Box 29140 Kampala, Uganda RCQHC P.O. Box 29140 Kampala Mob: +256772383914 RCQHC P.O. Box 29140 Kampala RCQHC P.O. Box 29140 Kampala RCQHC P.O. Box 29140 Kampala RCQHC P.O. Box 29140 Kampala, Uganda Help from USAID 2Meadaw Way Dorrey Road, buck, UK SL6ODS Department of Global Outreach American College of NurseMidwives,8403 Colesville Rd, 1550,Silver Spring MD 20910 American College of NurseMidwives,8403 Colesville Rd, 1550,Silver Spring MD 20910 Assist Project 7200 Wiscowsin DVE. Suite 600 Bethesda, MD. 20814 Association of Pediatrics American College of Obstetricians & Gynecologists 40912th St SW Washington DC 20024 Management Sciences for Health Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Quality Improvement Advisor Technical Advisor FP/RH Program Officer HIV/AIDS Technical Advisor Child Health and Nutrition/ Acting Director Programme Officer FPRH Program Officer Child Health Nutrition Program Assistant +256782253590 [email protected] +256312314200 Mob: +256788568336 Tel: +256312314200 [email protected] [email protected] [email protected] +256312314200 Mob: +256772434377 [email protected] +256312314200 Mob: +256752513034 +256312314200 +256752959494 +256312314200 +256782669841 07792185048 [email protected] and [email protected] [email protected] Vice President 2404851830 Cell: 5052507458 [email protected] Technical Advisor 240485-1832 [email protected] Director for Latin America Programs 3019418505, cell: 593999464102 [email protected] Doctor [email protected] [email protected]. uk Senior Director +12028632579 George.A.Little@dartmouth. edu [email protected] Director +16127034687 [email protected] Page 51 114. Prof. Doug Laube USA 115. Dr. Godfrey Sikipa USA 116. Edna Jonas USA 117. Dr. Sherri Bucher USA 118. Dr. Peter Johnson USA 119. Lillian Mutea 120. Dr. Lily Kak Washington D.C Survive & Thrive GDA American College of Obs/Gyn Washington, DC African Strategies for Health 430 North Fairfax Drive ARLINSTOG va 22203 Management Sciences for Health 4301, N. Fairfax Dr, Suite 400 Arlington, Virginia 22203 Survive & Thrive GDA [email protected] Project Director 7033103529 Cell: 9199496609 [email protected] Principal Technical Advisor Maternal, Newborn and Child Health Specialist African Strategies for Health Project +1 (703) 524-6575 [email protected] IUSOM America Academy of Pediatrics 699 Riley Research Drive RR208 Indizazepdis, IN 46202 Jhpiego 1615 Thames Street Baltimore USA Assistant professor of Pediatrics Director of Global Learning, Jhpiego +14109488603 [email protected] USA USAID/K +254714606517 [email protected] USA USAID Washington DC 2027121784 [email protected] 121. Mrs. Mary Ellen Stanton 122. Mrs. Donna Vivio USA 123. Zambia USAID 1405 Cda Dr Mclean VA 22101, 12027124208 USAID Washington DC Africa Network for Associate Clinicians (ANAC), P.O Box 33991,Lusaka, Zambia Nurses Association (ZUNO) P.O. Box 50375, Lusaka, Zambia MNCH/RHFP Drug Management Specialist Senior Advisor for Global Partnerships and Newborn Health Senior Maternal Health Advisor Senior Newborn Health Advisor Programmes Officer Mr. Paul Chungu 124. Mr. Thom Dauti Yungana USA Zambia Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania President (317)504-0141 (US) [email protected] [email protected] +13018018198 [email protected] +260211281031 +260977640504 +2600211281869 +260974216387 [email protected] Page 52 [email protected] 125. Mrs. Martha Ndhlovu Zambia 126. Ms. Regina Gerede Zimbabwe 127. Ms Cynthia MZ Chasokela Zimbabwe 128. Mrs. Khumbulani Mbuya Zimbabwe 129. Zimbabwe 130. Nyandoro Margaret Regina P. Smith Zimbabwe MCHIP Jhpiego P.O. Box 36873 Lusaka Ministry of Health and Child Welfare, P.O. Box C1122, Causeway Ministry of Health and Child Welfare,P.O. Box CY1122 Causeway, Harare, Zimbabwe Ministry of Health and Child Welfare,89/7701, Mpopoma Bulawayo, Zimbabwe Reproductive Health Ministry of Health and Child Welfare, P.O. Box CY1122 Causeway, Harare, Zimbabwe Zimbabwe Nurses Association ZINA,NO.6 Durland Close mt Pleasant,Harare Zimbabwe Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Technical Advisor +2601256255 Mob: +260977891062 +263772887793 [email protected] +263712394141 +263712878014 [email protected] Research Nurse +263776257316 [email protected] Deputy Director +263772325918 [email protected] Deputy Director Community Nursing Director Nursing Services [email protected] Fax: +2634794734 President Tel: 04700479 or 04303601 Mob: 0772352867 Page 53 [email protected] [email protected] APPENDIX 3. COUNTRY ACTION PLANS Appendix 3a. Burundi country plan DESIRED RESULTS/ OBJECTIVES BARRIERS/ CONSTRAINTS 1. Reduce Maternal Health by PPH from 15% to 7,5% in 2015 Lack of guidelines in HMS/HBB/HBS 2. Reduce neonatal death by asphyxia by 50% 3. Improving knowledge and skills in HMS and HBB through health workers in MNCH at all levels of the health system Lack of skilled providers in HMS/HBB Lack of new devices using in MNCH STRATEGIES/ ACTIVITIES PEOPLE RESPONSIBLE Updated guidelines in HMS/HBB/HBS MoH, HPA’s, NGO Produce SOP’s in MNCH Providing training’s in HMS/HBB/HBS to health workers in MNCH Make available new devices such as simulators, medical equipment in all health facilities RESOURCES MoH, WHO, UNICEF, USAID and other partners TIMELINE INDICATORS OF SUCCESS Number of guidelines drafted MoH (NRHP) MoH and HPA Technical teams in MNCH Number of SOP’s produced Number of HW trained MoH, Funders (USAID, WHO, UNICEF, UNFPA, Laerdal, J&J, etc. Regional collaborations (RCQHC, PA, WPA, RPA, etc.) Number of HF provide HMS, HBB, HBS MMR to T12, T24 Monitoring and evaluation NNMR to T12, T24 Appendix 3b. Kenya country plan DESIRED RESULTS/ OBJECTIVES BARRIERS/ CONSTRAINTS STRATEGIES/ ACTIVITIES PEOPLE RESPONSIBLE RESOURCES TIMELINE 1. Good governance, leadership and management Inadequate M4 (money, materials, minutes and manpower) Weak linkages between professional associaitons, the disciplines and donor agencies Consolidate materials/resources Prepare trainings Conduct trainings Collate and share best practices in management, governance and leadership across profesional associations Conduct trainings for profesional associations (CPD) Share contacts for the directors with members (email, Facebook, twitter, Skype) Formation of stakeholders network Train MNCH providers Arusha group 4 Ms Two years Inadequate or lack of supplies Inadequate personnel Logistics Access 2. Reduce maternal and newborn morbidity and mortality INDICATORS OF SUCCESS Workshop reports Best practices manuals (financial, human resource, strategic plan, business plan) Professional Association Leadership Strategic partners (ECSA, RCQHC, USAID) Feedback from members Growth in membership Arusha group MOH, NCK, COCK NNAK, KOGS, KMA, KPA, KCOA Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania 4 Ms Two years Page 55 Minutes of meetings Materials available and disseminated Training schedules and reports Train 150 maternal and newborn care providers in EmONC, HBB, HBS in selected high volume facilities Other strategic partners: ECSA-HC, RCQHC, USAID Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Number of providers trained Number of mothers and newborns managed Page 56 Appendix 3c. Lesotho country plan DESIRED RESULTS/ OBJECTIVES BARRIERS/ CONSTRAINTS STRATEGIES/ ACTIVITIES PEOPLE RESPONSIBLE RESOURCES TIMELINE INDICATORS OF SUCCESS 1. Decrease newborn mortality by improving Helping Babies Breathe Limited capacity Limited resources for training Sensitization of stakeholders Identify mentors Mobilize resources Conduct training MNCH manager HBB trained officer Professional associations TA Training materials Including models Within 12 months Reduction in number Of children dying in asphyxia 2. Reduce maternal mortality by improving care on bleeding after birth Limited capacity Limited resources for training Sensitization of mentors Identify mentors Mobilize resources Conduct training MNCH manager HMS trained officer Professional associations TA Training materials including models Within 12 months Reduction in number of women dying from PPH Limited Capacity Limited resources for training Resistance from other associations Conflict of interest Capacity building of the association executives Get government buy-in as well as NGOs and other associaitons Lobby for more membership Resource mobilization Midwifery Association TA Funding Infrastructure Equipment 18 months Functional active associations 3. Strengthen Professional Associations Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 57 Appendix 3d. Malawi country plan DESIRED RESULTS/ OBJECTIVES BARRIERS/ CONSTRAINTS STRATEGIES/ ACTIVITIES PEOPLE RESPONSIBLE RESOURCES TIMELINE INDICATORS OF SUCCESS 1. To create/reinforce HMS awareness Funds Briefings to Management and TWG Country Team Funds 26-30 August Number of management teams briefed/reports 2. To improve MNH through reduction of PPH Funds Inadequate models Computers Resource mobilization (proposals to potential donors) Trainings for HCWs Country Team GDA HR Funds January 2014 3. To strengthen professional associations Funds Computers Stationery Country team GDA partners Funds HPA leadership 4. To join community of practice Funds Technical support Lack of computers Lack of internet services Association Secretariat Funds Computers Internet services Technical support Involvement of PAs in all MN activities Join community of practice through ECSA and participate actively Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Proposal developed and submitted Funds mobilized Page 58 1st quarter 2014 Number of HCWs trained Reports MNH indicators As soon as ECSA develops CoP Interactions with other profesional associations through the CoP Appendix 3e. Mauritius country plan DESIRED RESULTS/ OBJECTIVES BARRIERS/ CONSTRAINTS STRATEGIES/ ACTIVITIES PEOPLE RESPONSIBLE RESOURCES TIMELINE INDICATORS OF SUCCESS 1. Reducing incidence of eclampsia Resistance of clinicians to using MgSO4 Patients not attending hospital in time Use of MgSO4 in all regional hospitals Educate all doctors and midwives Set up protocols Awareness campaign of community MOH: Steering committee executives, PS Consultants Specialists Midwives Pharmacists Educators Media-reporteurs Laboratory technicians MgSO4 Laboratory facilities Skilled HR 3 months: MOH 6 months: training protocols 12 months starts Patients not having eclampsia after RX Increased use of MgSO4 Reduction of maternal mortality 2. Capacity to advocate with MOH Resistance to change—MOH Unwillingness to incest more financial resources Meetings Lobbying Training members Pressure groups Presidents negotiators Online training packages Training centres Six months MOH convinced about positive outcomes Feasibility Resources available Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 59 Appendix 3f. Rwanda country plan DESIRED RESULTS/ OBJECTIVES BARRIERS/ CONSTRAINTS STRATEGIES/ ACTIVITIES PEOPLE RESPONSIBLE RESOURCES TIMELINE INDICATORS OF SUCCESS Reduction of maternal mortality rate by AMTSL utilizing HMS model Need more TOTs Funding limitations MOH needs to buy into the idea Discuss and present to MOH Mobilize for funds Train TOTs at district level Obs-Gyn Association Nursing Association Pediatrice Associations Clinical officers association Allied health associaitons in collaboration with MOH HRH Logistics Local leaders Opinion leaders Mobilization of leaders One day training of TOT 5 day training of district hospitals/Health centers M&E Decreased PPH Decreased length of stay in hospital Decreased MMR Decreased use of blood products Decreased infection Number of trainings carried out Number of trainees Numbers of trainees retained in MCH department By strengthening Health professions, improve MCH Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania One year period altogether Page 60 Appendix 3g. Seychelles country plan DESIRED RESULTS/ OBJECTIVES BARRIERS/ CONSTRAINTS STRATEGIES/ ACTIVITIES PEOPLE RESPONSIBLE RESOURCES TIMELINE INDICATORS OF SUCCESS 1. Reduction in birth asphyxia Resources (eg, venue) Number of models of Neonatalie Sensitization of HR and personnel Organized training program Projecting writing/funding MOH CNO Midwives/nurse Pediatricians Model of Neonatalie Venue Funding 2-4 weeks 4 weeks 9 months Percentage of reduction of infants with birth asphyxia Number of trainings conducted Number of trainees Difficulty in mobilizing nurses to attend meetings (inner islands) Attitude of nurses midwives attending meetings after working hours Sensitize nursemidwives on the importance of meeting Preparation and organization of meeting Set committee after meeting to work on draft Validation of draft (in meeting) Final completion NARS President and executive members Venue Nurse-midwives 1 month 2. Develop a strategic plan that is owned by members Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania 1 month 2 months Final strategic plan (6 months) Page 61 Number of nurses/midwies participating in the development of strategic plan Availability of strategic plan that members feel ownership for Increased number of members taking part in activities of the association Appendix 3h. Swaziland country plan DESIRED RESULTS/ OBJECTIVES BARRIERS/ CONSTRAINTS STRATEGIES/ ACTIVITIES PEOPLE RESPONSIBLE RESOURCES TIMELINE INDICATORS OF SUCCESS 1. To improve clinical competencies through simulation Lack of infrastructure and equipment (demonstration labs) No trained technical people to manage the labs Training/capacity building HBB Training institutions of Nursing/midwifery University of Swaziland Finance Human Resources Training materials (models) 12 months Reports Number of trainings conducted Number of participants trained 2. To ensure/enhance members’ engagement and enthusiasm for the association Lacking finances Consultative meetings for the members Nurses’ association Finance Human resources venue 12 months Number of consultative meetings held Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 62 Appendix 3i. Tanzania country plan DESIRED RESULTS/ OBJECTIVES BARRIERS/ CONSTRAINTS STRATEGIES/ ACTIVITIES PEOPLE RESPONSIBLE RESOURCES TIMELINE INDICATORS OF SUCCESS 1. Leadership and management capacity Lack of full time office secretary Low commitment and involvement from members Lack of committed leaders—volunteer basis Train leaders and potential leaders on management skills Improve network on leadership skills among members Establish full paid secretariat Twinning—stronger association Establish fund raising strategy Associations Stakeholders: USAID Venue (office) Technical personnel Finances 2013-2019 Increased membership Increased number of skilled and committee leaders Full time secretariat Projects 2. Reduce MMR from 454 to 300/100,000 Lack of skilled HCW Poor commitment of decision makers at facility level Poor infrastructure Lack of equipment Uneven distribution of health workers Poorly motivated HCW Poor working conditions Train HW on HMS Orientation and sensitization on MMR—policy makers and decisión makers Community awareness: MMR Birth preparedness Support Health center initiative Available Health systems MOH and professional Associations Professional Associations Professional Associations MOH Media peer groups community leaders Training resources (mama Natalie) Financial Human resources Master trainers for TOT September 20132014 Increased number of skilled professional Decreased number of mothers with PPH Increased numbers of mothers attending facilities for deliveries Decreased MMR Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 63 Appendix 3j. Uganda country plan DESIRED RESULTS/ OBJECTIVES BARRIERS/ CONSTRAINTS STRATEGIES/ ACTIVITIES PEOPLE RESPONSIBLE RESOURCES TIMELINE INDICATORS OF SUCCESS 1. Integrate AMTSL and HBB Reduce maternal deaths due to PPH by 50% within 12 months Reduce deaths from birth asphyxia by 50% within 12 months in one region Train 500 maternal and newborn care providers in quality improvement Limited knowledge Skills deficiency Limited supplies Poor staff attitudes Weak leadership Inadequate staff numbers Training in : HMS/AMTSL/HBB and quality improvement Supportive supervision Equipment supply Hold community of practice meetings to identify challenges and success Mentorship Advocacy for policy implementation at the national level Professional Associations AOGU-UMA UPA AHPC MOH NIM IMECOA USAID and other partners Training materials and equipment Facilitation for the training Trainers Mentors Support and supervision 1st quarter for 3 months Number of Health workers trainied Number of supportive supervisión visits Number of Health workers visited Number of community meetings held Number of Health workers mentored Policy change made to include HBB and HBS into EMOC and ENBC Reduction in death secondary to PPH and asphyxia 2. To update 50% of all professional association members on Lack of reports on malpractices Attitudes Training 50% of members of professional associations in ethics and Professional Associations and Councils Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Facilitator for meeting with ECSA, RCQHC, USAID and other partners Training materials Trainers Facilitation Reports of cases sent to council Page 64 On going supervisión By end of 12 months By end of 18 months 12 months Number of association members trained Number of training reports ethics and professionalism 3. Advocate for increase in number of critical human resources Willingness and availability of members Recruitment: Underfunding Low implementation of attraction and retention policies for health workers professionalization; customer care; leadership and management Meetings to engage MOH with Parliamentarians Central government executives Public service Ministry of finance Number of trainings Executives of the professional councils Professional associations Civil society organization Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Training materials Trainers facilitators Page 65 12 months Number of reports Appendix 3k. Zambia/Botswana country plan DESIRED RESULTS/ OBJECTIVES BARRIERS/ CONSTRAINTS STRATEGIES/ ACTIVITIES PEOPLE RESPONSIBLE RESOURCES TIMELINE INDICATORS OF SUCCESS 1. Improve maternal and newborn care through respectful maternal care (RMC) Acceptability /attitudes of professionals Conduct research/ baseline study on RMC Professional association Skilled human resources Research – 1 year Results of research/study available Lack of funding Develop RMC program resource mobilization Skilled personnel for project development and management Capacity building in RMC Project development and piloting – 1 year Government Funds Development partners Technical support Training institutions/universities Infrastructure Regulatory bodies (2014-2019) Advocacy for project with stakeholders Funds available Technical support available Improved attitudes of professionals Develop and dissemination of patient’s charter on RMC Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Project implementation – 3 years RMC established in pilot localities Patient’s charter on RMC developed and disseminated to all facilities (Government, Pas, trainers, institutions, NGO’s, etc.) Page 66 Appendix 3l. Zimbabwe country plan DESIRED RESULTS/ OBJECTIVES BARRIERS/ CONSTRAINTS STRATEGIES/ ACTIVITIES PEOPLE RESPONSIBLE RESOURCES TIMELINE INDICATORS OF SUCCESS Reduce maternal/newbor n mortality rates by 25% by 2014 Skilled manpower Road network Communication network Training staff in EmONC Supportive supervisión On the job training Sensitization of profesional associations Follow-up MOH Technical assistance Teaching Aids Finance Ongoing Number of people trained Impact assessment in 2014 Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 67 Forum organizers, facilitators and GDA members Regional Maternal and Newborn Care Forum, 19-23 August, Arusha, Tanzania Page 68
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