Ghana Neonatal Quality Improvement Initiative
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1 Ghana Neonatal Quality Improvement Initiative A collaborative project with between the Ghana Health Service, the World Health Organization, & Johns Hopkins University Third Partners Meeting on Better Medicines for Children Program Update November 22, 2011
2 Steering Committee Cynthia Bannerman (Chair) Mary N. A. Brantuo Fizan Abdullah Director Institutional Care Division Ghana Health Service National Professional Officer Child and Adolescent Health World Health Organization Accra Associate Professor of Surgery & International Health Johns Hopkins University
3 Project Collaborators WHO HEADQUARTERS GENEVA Clive Ondari Scientist,Essential Medicines and Pharmaceutical Policies, World Health Organization Geneva Suzanne Hill Scientist, Essential Medicines and Pharmaceutical Policies, World Health Organization Geneva Deirdre Dimancesco Technical Officer, Essential Medicines and Pharmaceutical Policies, World Health Organization Geneva WHO ACCRA Edith Andrews Annan National Professional Officer, Essential Medicines, World Health Organization Accra
4 Project Collaborators GHANA HEALTH SERVICE HEADQUARTERS Elias Sory Director General (former), Ghana Health Service Martha Gyansa Lutterodt Chief Pharmacist / Director Pharmaceutical, Ghana Health Service / Ministry of Health Isabella Sagoe Moses Child Health Coordinator, Family Health Division, Ghana Health Service GHANA DEMOGRAPHIC SURVEILLANCE SYSTEMS Abraham Hodgson Director of Health Research and Development Division, Ghana Health Service John E. Williams Director (former), Navrongo Demographic Surveillance System, Ghana Health Service Alex Oduro Director, Navrongo Demographic Surveillance System, Ghana Health Service Margaret Gyampong Director, Dodowa Demographic Surveillance System, Ghana Health Service Seth Owusu Agyei Director, Kintampo Demographic Surveillance System, Ghana Health Service KORLE BU TEACHING HOSPITAL ACCRA Jennifer Welbeck Professor, Korle Bu Teaching Hospital, University of Ghana Christabel Enweronu Laryea Senior Lecturer, Korle Bu Teaching Hospital, University of Ghana Afua Hesse Director of Medical Affairs, Korle Bu Teaching Hospital, University of Ghana KOMFO ANOKYE TEACHING HOSPITAL KUMASI Larko Owusu Paediatrician, Komfo Anokye Teaching Hospital Francis Abantanga Associate Professor of Surgery & Chairman, Komfo Anokye Teaching Hospital REGIONAL & DISTRICT HOSPITAL STAFF Stella Adjei Paediatrician, Sunyani Regional Hospital Ernest Opoku Deputy Director Clinical Care, Upper East Region Abdulai Adams Forgor Medical Superintendent, Kintampo District Hospital Damien Punguire Medical Superintendent, Navrongo District Hospital Kennedy Brightson Medical Superintendent, Dangme West District Hospital
5 Project Collaborators Trainers Dr. Juliana Ameh Lead Trainer, NQI Initiative, La General Hospital, Accra Dr. Nana Okai Brako Team Captain, Ridge Hospital, Accra Dr. Frederick Boahene Team Captain, Ridge Hospital, Accra Mrs. Selina Dussey Team Nurse, Accra Ms. Serwah Amoah Team Nurse, Accra Elizabeth Cristofalo Assistant Professor of Pediatrics, Division of Neonatology, Johns Hopkins University, Baltimore Johns Hopkins University Mira Mehes Research Assistant, Johns Hopkins University Gezzer Ortega Research Fellow, Johns Hopkins University
6 Disclosures World Health Organization Bill & Melinda Gates Foundation
7 Neonatal Quality Improvement (NQI) Background Philosophy & Initiative Overview Timeline & Project Update
8 Background: 70% of 7.4 Million Global Deaths Under Age 5 occur in Infants
9 Neonatal Quality Improvement (NQI): Global Mortality Data Annual Neonatal Deaths (2010) Developed Regions (High Income Countries) Less Developed Regions (Low and Middle Income Countries) 53,000 3,019,000 World 3,072,000 Source: UNICEF, Levels and Trends in Child Mortality, Report 2011
10 NQI: Causes of Death among Children Under 5 Years (2008 percentages) Asphyxia & sepsis account for 37% of all neonatal deaths Source: United Nations. MDG Report 2010
11 Two Big Neonate Killers that are treatable: Asphyxia & Sepsis
12 Background: Multiple WHO programs targeted at Neonate Priority Medicines / Essential Medicines Specific Vit A, HIV guidelines Feeding Guidelines Helping Babies Breathe EMONC Kangaroo Medical Care Pocketbook of Hospital Care of Children
13 Background: Existing Data Collection System Health and Demographic Surveillance Systems (HDSS) Three HDSS sites: Navrongo, Kintampo, Dodowa Longitudinal registry of population dynamic pertaining to births, deaths, marriages, migrations Platform to test and evaluate impact of health service interventions and to support health service research
14 NQI: Philosophy & Approach Back to the Basics Simple Horizontal Integration Health Systems Strengthening Across classically vertical programs as well as within Ghana across Departments and Institutions Measurable Outcome with Rigorous Data Collection Locally led Collaboration of national, regional, and local government and clinical partners Scalable & integrates into current health care delivery system
15 NQI: Objective Horizontal Integration of WHO guidelines in combination with on site clinical education and close followup/reinforcement with the aim to improve the quality of care of neonates at the district hospital level in Ghana by focusing effort exclusively on neonatal asphyxia & sepsis
16 NQI: Map of Intervention Sites Intervention Sites: Navrongo War Memorial District Hospital Kintampo District Hospital Delayed Implementation Site: Dangme West (Dodowa) District Hospital
17 NQI: Project Flow Chart Initial Assessment District Hospitals Navrongo (Program) Kintampo (Program) Dodowa (Control) Essential Medicines & Equipment Support Essential Medicines & Equipment Support Interval Assessment District Hospitals Navrongo (Program) Kintampo (Program) Dodowa (Control) Site Assessments & Baseline evaluation Month 1 Clinical Refresher Training and International Team on site Support Regional Clinical Visits Months 2 6 Month 7 Months 8 12 Month 13 Monthly Visits by Clinical Team Clinical Refresher Training and International Team on site Support Regional Clinical Visits Monthly Visits by Clinical Team Data Analysis Evaluation of facility and populationbased data from three Demographic Surveillance systems and District Hospitals.
18 Initial Assessment District Hospitals Navrongo (Program) Kintampo (Program) Dodowa (Control) Essential Medicines & Equipment Support Essential Medicines & Equipment Support Regional Clinical Visits Regional Clin Site Assessments & Baseline evaluation Month 1 Months 2 6 Month 7 Months Clinical Refresher Training and I t ti lt Monthly Visits by Clinical Team Clinical Refresher Training and Mon Visit Clin Te
19 Interval Assessment Essential Medicines & Equipment Support District Hospitals Navrongo (Program) Kintampo (Program) Dodowa (Control) nical Visits ths 2 6 Month 7 Months 8 12 Month 13 thly s by cal am Clinical Refresher Training and International Team on site Support Regional Clinical Visits Monthly Visits by Clinical Team Data Analysis Evaluation of facility and populationbased data from three Demographic Surveillance systems and District Hospitals.
20 NQI: Specifics Provide clinical refresher training to health care providers using a curriculum based on GHS/MOH standards & WHO guidelines for neonatal resuscitation and management of sepsis. Monitor neonatal morbidity and mortality outcomes at the facility and community level in partnership with existing Health & Demographic Surveillance Systems Engagement of leadership, close supervision and follow up of implementation efforts, empowerment of local experts and stakeholders, rigorous monitoring of outcomes using wellestablished best available resources
21 National Ghana Health Service Headquarters Program Support Feedback Region Regional Director NQI National/Regional Clinical Supervisor Hospital Level District Hospitals NQI District Project Manager
22 NQI: Rigorous but Simple Data Collection System Monthly Reports (real time): Community Total pregnancies, births (live and still), and neonatal/infant deaths Facility Total pregnancies, admissions, births (live and still), and neonatal/infant deaths Annual Reports: Community Total births (live and still), and neonatal/infant deaths Facility Total births (live and still), and neonatal/infant deaths
23 NQI: Facility Assessments Completed September 2011
24 NQI: Timeline Activity Dates Details Facility Assessments Sept 2011 Planning Meetings Sept 2011 Clinical Refresher Training Jan 2012 Baseline site assessments: Navrongo, Kintampo, Dodowa District Hospitals Meeting with key stakeholders: WHO, GHS/MOH, Johns Hopkins Hopkins, trainers, facility reps Clinical training teams at Navrongo and Kintampo District Hospitals Regional Clinical Visits Feb June 2012 Regional clinical visits to Navrongo and Kintampo District Hospitals Clinical Refresher Training July 2012 Clinical training teams at Navrongo and Kintampo District Hospitals Regional Clinical Visits Year End Facility Assessments Aug Dec 2012 Jan 2013 Regional clinical visits to Navrongo and Kintampo District Hospitals Final assessment at all three District Hospital Sites
25 Assessment of Drugs & Equipment
26 Assessment of Drugs & Equipment
27 NQI: Clinical Refresher Training Clinical Refresher Training Round 1: January 2012 Clinical Refresher Training Round 2: July week Clinical Refresher Training focused on newborn resuscitation, the treatment of sepsis and Kangaroo Mother Care. Curriculum being developed by team of Ghanaian pediatric experts (GHS and WHO country office) with technical support of Johns Hopkins pediatric/neonatal consultants Curriculum based on WHO Pocket Book of Hospital Care for Children, the WHO/American Academy of Pediatrics Helping Babies Breathe program and WHO/UNICEF s Kangaroo Mother Care teaching materials.
28 NQI: Monthly Clinical Site Visits Regional Clinical Visits: Feb June & Aug Dec 2012 Regional Clinical Supervisors assigned to Navrongo and Kintampo District Hospitals will conduct monthly site visits Training teams will accompany RCSs for monthly clinical site visits on an alternating monthly basis. District Hospital Medical Superintendents will be present and available on site to monitor project progress and to provide support as required.
29 Neonatal Quality Improvement (NQI): Conclusions I Successful formation of NQI initiative developed to strengthen quality of neonatal care with partners including: Ghana MoH/Ghana Health Service World Health Organization Johns Hopkins University Our NQI Initiative reflects domestic prioritization and commitment from Top Level Management of all involved collaborating organizations. Ghana Health Service has identified priority areas: Medicine/drug and equipment distribution, availability and use Case management practices for sick neonates and children
30 Neonatal Quality Improvement (NQI): Conclusions II NQI program begins to address facility based health systems improvement in a scalable way Horizontal Integration of Programs Not just vertical program development Using Existing World class Outcomes Infrastructure (DSSs)
31 Acknowledgements Madelyn Teves Clemente Essential Medicines Geneva Joanna McMahon Essential Medicines Geneva Gladys Obuobie Ghana National Drugs Program Accra
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