While field activities were paused for two months as a result of government directives in response to the COVID-19 pandemic, this did not majorly disrupt activities and the SBL team were able to use the time away effectively whilst continuing to engage with beneficiaries through e-mentorship.
The SBL programme continues to enjoy strong relationships and engagement with all stakeholders and continues to coordinate closely with relevant government bodies.
Community Interventions
The SBL team, in collaboration with Village Heath Support Groups (VHSGs) created a teaching programme and one of the key outputs achieved during this reporting period is the finalisation of the VHSG training handbook. There is currently no such resource available in Cambodia for VHSGs.
The 55-page VHSG training handbook covers the lecture series conducted by the SBL team to support the VHSGs in their own neonatal heath knowledge and teaching capacity. Topics include importance of good antenatal care and promoting health centre delivery, when to go to the health centre, congenital abnormalities, danger signs in the newborn and other relevant neonatal health topics.
The handbook has the potential to fill a big gap in terms of available government training tools and the SBL team is aiming to bring the handbook to the Ministry of Health as an aid for VHSGs across the country.
Health Centre Interventions
Interventions at the health centre/post level focused on mentorship including the ongoing medium intensity mentorship in the Pilot Phase clusters (4 health centres and 4 health posts) and the commencement of high intensity mentorship in Stage 1 health centres/posts (11 health centres and 8 health posts).
For both Pilot and Stage 1 clusters, e-mentorship was conducted during the COVID-19 pause in face-to-face activities. Using the messaging app Telegram, SBL team members sent daily messages over a week period including case studies and suggestions on self teaching. E-mentorship was very beneficial in that it allowed the SBL team to maintain an active relationship with the health centre/post staff and show our commitment.
A notable achievement to highlight during this stage is the improvements in the mentor’s ability and confidence from the Pilot to the Stage 1 clusters. This is reflected anecdotally in the neonatal outcomes for the Stage 1 clusters where the team is seeing positive changes earlier in the intervention process.
Referral Hospital Interventions
The Preah Vihear Referral Hospital completed its medium intensity mentorship in June 2020 with mentors on site three weeks each month. Similar to the health centre/post mentorship, the SBL team relied on e-mentorship when staff were not able to conduct face-to-face mentorship due to COVID-19.
In addition to mentorship activities, preparations are underway to prepare the Preah Vihear Referral Hospital to host clinical attachments for the Cheam Ksan Referral Hospital. Activities with Cheam Ksan have had to be postponed due to the COVID-19 situation, the Preah Vihear Referral Hospital needing additional time with mentorship, and because a key staff member will go on maternity leave.
Given the breadth of activities and stakeholders related to the SBL programme, all actors have been collaborative and flexible; this is especially true of Preah Vihear Referral Hospital Director, who has provided his full and enthusiastic support and cooperation for all interventions thus far. Staff commitment in Preah Vihear Referral Hospital’s new Neonatal Unit has been high throughout the project.
Case study: Rovieng Health Centre
It is a typically busy morning at Rovieng Health Centre in Preah Vihear Province; dozens of motorbikes are parked outside and many mothers and children sit beside the designated obstetrics, antenatal and delivery room building. That previous night, three babies had been born, adding to the buzz of activity. The SBL team has been visiting the health centre every month since the Saving Babies Lives (SBL) programme started, to train the staff on neonatal healthcare.
Rovieng plays an important role in the province’s healthcare because of the large population reliant on its services, its distance from the main referral hospital, and the high number of births delivered each month. Rovieng is also one of the four pilot health centres participating in the SBL programme.
On this month’s visit, Saradeth is teaching correct intravenous administration of antibiotics when a sick neonate requires urgent transferring to the Preah Vihear Referral Hospital. Rovieng Health Centre is located over 1.5 hours’ drive from the referral hospital, meaning correct transfer of sick neonates is a crucial procedure for the health centre staff to follow.
Sim Chanmetrey is one of the dozen midwives working at Rovieng Health Centre since 2015. Her team delivers approximately 30 babies per month, the highest of any health centre in Preah Vihear.Some of the babies born here require urgent care like emergency resuscitation. Chanmetrey recalls her own difficulty caring for newborns before she began SBL training.
Chanmetrey has been a regular attendee at SBL training sessions since the programme began. She was selected as one of the ToTs (Training of Trainers) for Rovieng because of her commitment, motivation, and enthusiasm. Recently, she has been familiarising herself with the BaRT system, which the SBL team introduced to the health centre in June 2020. BaRT teaches health workers how to resuscitate a neonate by measuring air pressure and pace delivered on an app, giving them real-time feedback when they are performing resuscitation.
Each week Chanmetrey meets with her fellow midwives to train them on the BaRT system. Last week she had to use her BaRT training when a baby stopped breathing shortly after birth.
Rovieng Health Centre has now entered the final stages of the mentorship programme. This means the SBL team only visits one day per month with Chanmetrey, and the other two ToTs at Rovieng, leading the majority of training. “The team here (at Rovieng) continues showing us examples of their improvement,” says Saradeth, “It shows in the statistics but also in the cases we are seeing of sick babies being saved.” Ultimately, the team at Rovieng will have the skills and knowledge needed to continue improving neonatal healthcare in their area without the need for the SBL team’s guidance.
Looking forward and outward
Key activities for the second half of 2020
Referral Hospitals
The Preah Vihear Referral Hospital will complete its final phase of low intensity mentorship where mentors will provide support once every two months. During this period, preparations will also be underway to begin activities in Cheam Ksan Referral hospital in January 2021.
Monitoring and evaluation
Baby Surveys and Verbal Autopsies across the province will continue as normal. The SBL team will also continue regular coordination with government counterparts including monthly meetings with the Preah Vihear Hospital Director and Ministry of Health.
Innovating through action
AHC finally started field testing for its low-cost neonatal resuscitation system (BaRT) which we are hoping will make a significant and positive impact on how health workers in rural poorly resources areas build and maintain their skills.
The system was tested in SBL programme pilot health centres for the first time in June 2020 and will be field tested for three months. This phase of testing includes teaching about the system and how it should be utilised, leaving the system with staff and collecting end user feedback, assessing device generated feedback (frequency of use, accuracy improvement of neonatal resuscitation skills) and assessing of the users’ neonatal resuscitation skills.
If the BaRT system is successful, it will support rural health workers in Preah Vihear and potentially across Cambodia and in other low resource settings globally to sustainably reduce neonatal mortality related to birth asphyxia.
BaRT: Helping healthcare workers maintain neonatal resuscitation skills
Disseminating key learnings
Programme sustainability is at the heart of the SBL programme, and has been taken into consideration at all levels of implementation to ensure a lasting impact on project beneficiaries. One of the ways this is achieved is through sharing programme learnings, results, and methodologies in international peer-reviewed journals.
In May 2020, a paper on barriers and facilitators to neonatal health and care-seeking behaviours in rural Cambodia was accepted and published by the BMJ. The paper, which covers the community work as part of the SBL programme, aimed to identify influencers of neonatal health and healthcare-seeking behaviour in Preah Vihear. It is the first study to be published as part of the SBL programme.
Follow our progress on the SBL partner dashboard
The SBL partner dashboard is still updating real-time data on programme activities and helping us share progress on activities. The dashboard can be accessed from this link: angkorhospital.shinyapps.io/SBL_Partners
Find recent articles and video resources about our Saving Babies' Lives programme here.
Credits:
Joe Patchett @AHC.org