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Saving Babies Lives Programme Update: January – June 2019 ANGKORHOSPITAL.ORG

The past six months have been an important time for the SBL programme. Initiatives in the community, health centres and referral hospital were rolled out in full during this period, highlighting both lessons to learn and challenges.

One of the key achievements so far has been the buy-in from stakeholders at all levels of the programme from the Village Health Support Group workers (VHSGs) to the Provincial Health Department. We have seen VHSGs taking the initiative and request additional training, health centres taking on board suggestions, to our training programme being officially recognised and endorsed by the Nursing, Midwifery, and Medical Councils of Cambodia.

Community interventions

Activity spotlight: Participatory Action Research

At the community level, interventions have focused on mobilising over 500 Village Health Support Group workers (VHSGs) through the completion of Baby Surveys using the verbal autopsy tool developed in the last reporting period and Baby Health Meetings.

These activities not only track ongoing trends in neonatal mortality and provide real time neonatal health statistics, but also help to shed light on the underlying causes and systems that contribute to neonatal mortality.

Participatory Action Research (PAR) during the Baby Health Meetings in the intervention groups is a key focus during this reporting period. Using PAR methodologies, VHSGs are identifying and prioritising problems with neonatal health in their communities, developing action plans, and implementing and assessing these plans. To date, 29 PAR sessions have been conducted and it is expected that implementation of solutions identified through PAR will begin in the next couple of months.

Participatory Action Research

Health Centre Interventions

Activity spotlight: Mentorship

Beginning in March 2019, the SBL team worked closely side by side with health workers to facilitate healthcare delivery through mentorship. Mentorship aims to support healthcare staff to become fully competent in the care of neonates in the health centres/posts, with the overall goal of improving the quality of neonatal care delivered.

Mentors were trained in and encouraged to use a range of teaching methods including lectures, simulation sessions, and real neonatal case teaching when mentors are present for deliveries and assessments. During the mentorship, health centre/post staff were also encouraged to present cases they have had or seen so that mentors can then lead discussion and learning points on them.

Very little literature exists on mentorship interventions in low-resource settings, thus the team has had to develop interventions and make relevant amendments to mentorship activities as the programme progresses which highlights the iterative nature of the SBL programme.

Baby Sopheak receives life-saving treatment at the Preah Vihear Referral Hospital.

Referral Hospital Interventions

Activity spotlight: Clinical Attachment

Following on from the referral hospital Neonatal Residential Training at the end of 2018, clinical attachments were conducted to prepare the referral hospital paediatric team to run their own neonatal unit, which was due to open after the clinical attachment with AHC’s support.

The contents of the course were developed by the SBL team and based on the Ministry of Health and WHO guidelines. The three-week course was designed to provide neonatal clinical experience, management experience on patient flow in a Neonatal Unit, and an overview of how the AHC Neonatal Unit is run. To support the daily experience on the Neonatal Unit, the clinical attachment programme also consisted of bedside teaching, case presentations, and lectures covering topics such as neonatal sepsis, complications of prematurity, and assisted feeding and fluids management.

In total 11 PVH referral hospital staff participated in the clinical attachment with all but one passing their final assessment. From formal feedback, all candidates thought the clinical attachment was very useful and that they felt more confident to change their practices following the course.

Clinical Attachment - January – March 2019

  • 11 PVH referral hospital staff (3 doctors, 8 nurses) attended the AHC Neonatal Unit for a three week clinical attachment

Establishing Neonatal Unit - March 2019

  • Five-bed Neonatal Unit created at Preah Vihear Referral Hospital
  • Equipment installed (including CPAP machine, 2 cots, bilirubin machines, 2 phototherapy machines, neonatal resuscitation kit and trolley, medication fridge, syringe drivers)
  • Referral Hospital maintenance team and paediatric team trained in all equipment maintenance

Mentorship - April 2019 - ongoing

  • Referral hospital mentorship package created
  • Competency books for both mentees and mentors
  • Monitoring and evaluation tool (‘cluster checklist’)
  • 2-3 mentors attending per week, for alternate weeks, for 6 months

Looking forward and outward

Key activities for the second half of 2019

The second half of 2019 will mark the end of the SBL pilot phase, an exciting time for the programme as all training interventions for each programme component will have been completed in full. This will allow for an initial evaluation of programme activities and adjustments of activities as necessary before rolling out interventions in subsequent SBL clusters.

CaMap of all target clusters in Preah Vihear Province.

Contributing to the global dialogue on neonatal mortality

Beyond Cambodia, AHC is using learnings from SBL to contribute to the global dialogue on neonatal mortality.

At the Royal Collage of Paediatrics and Child Health Conference in Liverpool, staff presented research conducted on SBL programme design and assessment tool creation, which can be used as a blueprint to develop similar programmes in other low-resource settings.

Read the abstracts:

Transforming neonatal learning in rural Cambodia: design of a comprehensive neonatal training programme for midwives, nurses and doctors in a rural province in Cambodia

Design of an assessment tool to evaluate neonatal care practice across a rural province in Cambodia

Follow our progress on the SBL partner dashboard

Data visualisation is a key component of the SBL programme - we want our partners to be able to see data that is being collected in a clear and informative manner. The SBL partner dashboard which has recently gone live is allowing for real time updates on programme activities and helping us share progress on activities. The dashboard can be accessed from this link:

angkorhospital.shinyapps.io/SBL_Partners/

SLB partner dashboard is live!
Thank you to our international partners:

angkorhospital.org

Credits:

Joe Patchett @AHC.org