shahidullah: national scaling up of helping babies breathe initiatives in bangladesh
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National Scaling Up of Helping Babies Breathe Initiatives in
Bangladesh
Prof. Mohammad Shahidullah
Chairman Neonatology Department and Pro-Vice Chancellor,
Bangabandhu Sheikh Mujib Medical University (BSMMU)
Dhaka, Bangladesh
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Presentation Outline
Background National scale up strategy
Evaluation design
Results to date Quality improvement process
Plans for sustainability
Lessons learned
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Background:
Facts of Neonatal Health in Bangladesh
Delivery at health facility -29%
Delivery attended by a skilledprovider -32%
Neonatal death per year is79,000 *
Neonatal mortality rate:32/1000 live births
Neonatal deaths - 60% of all
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Causes of Newborn Mortality in Bangladesh
Data source: Bangladesh-specific mortality estimates (Liu et al. 2012).
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Background of National Scale-up of HBB in
Bangladesh
National Dissemination & Stakeholder Meeting Political leadership, commitment
2010 - HBB PilotStudy conducted
in Bangladesh
by BSMMU
Series of stakeholders consultation to
develop HBB Scale-up strategy
HBB
curriculum
Adaptation toincorporate
ENC and
translated in
Bangla
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National Scale-up PlanCapacity Building
Training on NB resuscitation including primary management of birth asphyxiaand basic ENC to all SBAs (from highest level service provider to communitylevel) of Bangladesh (public sector)
Equip all the facilities of public health sector and cSBAs with resuscitator(neonatal bag & mask with sucker)
Quality Assurance Supervision and monitoring of training
MIS system strengthening and evaluation of the HBB scale-up activities
Sustainability
Incorporate in National Health Sector Program
Incorporate HBB protocol in all relevant in-service and pre-servicecurriculum
Capacity building of the facilities for training & refreshers training
Routine refreshers training for retention of skills and utilization of the NBresuscitation capacity
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Background of National Scale-up of HBB in
Bangladesh
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MOH&FW (DGFP, DGHS)
Overall implementation TAX/VAT of offshore procurement
MCHIP/Save the Children Nationwide Implementation, supervision,
monitoring and Evaluation
Ensure Logistics
BSMMU Adaptation of training materials
Organize training in all level
Monitoring and supervision
UNICEF
Equipment for district implementingmaternal and NB projects,
Supervision and monitoring
ICDDRB Evaluation of HBB scale-up activities
HBB Scale-up Partners in Bangladesh
Funding Arrangement
MOH&FW (Cash and kind)
USAID through
MCHIP/Save the Children
UNICEF
Laerdal Foundation
through Save the Children
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2 days TOT in BSMMU Trainer return
and provide training to
district and upazila SBAs
Step-wise HBB scale-up plan
6 districts
TOT- Doctors from
Medical College Hosp (if any),District Hospital, District
Health and FP Office andUpazila Health Complexes
Each StepTotal 11 steps
7-8 batches
Medical College Hosp
30 doctors and 40 nurses District Hospital- 6-8 doctors and 10+ nurses
MCWC- all doctors and FWV
UHC- 5-7 Medical Officer and all Nurses
All FWVs and CSBAs
Training starts immediately after TOT
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Plan of System Evaluation of Scaling-up of HBB Interventionin Facility and Community Settings in Bangladesh
10
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Status of HBB Implementation - Training
Category ReceivedTraining
Percentage
Doctor 3570 23%
Nurse 4104 26%
Paramedics 3783 24%
CSBA 4080 26%
Total 15537 100%
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13
Training and equipping
Mannequin (NeoNatalie-Laerdal)
Resuscitator & Suction device
Use for trainingand refreshers
Kept in all facilities
from UHC and
above for refreshers
training
Provided to use for training
and refreshers
Provided to all
facilities &
CSBAs for newborn
resuscitation
.
Type ofFacilities
No.Facility
NeonatalieComplite
Bag & Muskwith Sucker
Medical
Colleges
Hospital
18 43 54
District
Hospital38 76 86
Maternal andChild Welfare
Center
40 80 80
Upazila Health
Complexes302 604 604
Union Health
and Family
Welfare Center
2372 - 2372
NGOs Facilities 69 70 123
Community
SBA- - 4380
Total 2839 873 7699
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Training and equipping
Action plan
for training andhanged in delivery sites of the
facilities
Flipchart- for training
and kept in facilities for
refreshers training
Learner Workbook-provided to all trainee
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Incorporation of HBB Protocol in DifferentCurriculum
HBB Scale-up plan have the component to incorporate theHBB protocol in all relevant pre-service and in-servicecurriculum.
Following curriculum already incorporated the HBB
protocol.1. MBBS Curriculum2. Diploma and Degree course of Nursing3. Midwifery Training Curriculum4. FWV training Curriculum5. Private Paramedics Training Curriculum6. CSBA Training Curriculum
Incorporated in Standard Operation Procedure for NewbornHealth Care in Primary and Secondary level facilities
In the process of incorporation in Maternal Health SOP
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National Level (DGHS, DGFP BSMMU and SC ) Joint monitoring visit and follow-up of divisional officials visit
Divisional Level Health and FP officials Usually 1 district/division in each phase, so feasible for divisional
level to organize monitoring visit
District Health and FP officials visit each batch as resourceperson
UHFPO/UFPO/RMO coordinate the training of theirupazila/facilities
MNCH, MNH, MNCS and MaMoni and other similar programproviding support for supervision and supervise in the projectarea
Standard checklist use for supervision and monitoring
Quality Improvement
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Quality Improvement (Cont.)
Supervision and monitoring of training 90% session are expected to be supervised/monitored by District
level DGHS and DGFP officials
83% sessions observed by district level Health/FP managers
50% sessions will be monitored /supervised by BSMMU officials Monitoring visits with checklist (219 out of 786 sessions) training- 28% of
sessions)
QA through direct observation of master trainers (159 out of 786 - 20% ofsessions)
15% sessions are expected to be supervised by national anddivisional level DGHS/DGFP official
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Quality Improvement- Refreshers training
StepsComplet
e
A. Prepares for birth
Identifies a helper
Prepares the area for delivery
Cleans hands
Prepares an area for ventilation
Checks equipments
B. Dries thoroughlyDries the baby thoroughly
Removes wet cloth
C. Clears airway and stimulates
reathing if baby is not crying*
Keeps warm
Positions head and clears airway
Stimulates breathing by rubbing the
ack
D. Ventilates with bag and mask if
aby is not breathing
Cuts cord and moves to area for
entilation
Apply the mask to make a firm seal
Starts ventilation within Golden
Minute
(started at _________ seconds)
Ventilates at 40 breaths/min (30-50
acceptable)
(_________breaths per minute)*
Looks for chest movement *
E. Improve ventilation if chest does
not move*
Head: reapply mask and reposition
head
Mouth: clear secretions and open the
mouth
Bag: squeezes the bag harder
Refreshers training introducedthrough routine system
SBA describe the experience ofresuscitation to others in themonthly meeting if any newbornwas resuscitated
1/3rd of SBAs practice with themanikins and bag & mask underobservation of their trainedsupervisor as a routine practice
The supervisors take brief testand record it in a card given
during training All SBA have to practice and
record his/her performance inthe record card by every 3rdmonth
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Plans for sustainability
HBB program incorporated in the Health Population Nutrition Sector
Development the Program (HPNSDP) 2011-2016 and its Operation Plans
(OP) of the MNC&AH (DGHS) and MCR&AH (DGFP)
Curriculums and Newborn SOP incorporated the protocol
Refreshers training introduced through routine system
Developing a video for refreshers training and distribution to all thefacilities are under way
Regular review meeting in directorates are going way.
MIS incorporation under process,
A Technical Sub-Committee on Finalization of Newborn Indicator havebeen formed and are working
DGFP is now piloting HBB related indicators
Surveillance activities are planned
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Lessons learned
Rapid scaling-up of an public health intervention becamepossible due to the-
Political Commitment
Systemic Cascade Approach
Technical Capacity
Partnership and
Fund Availability
Still the Challenges of HBB Scale-up are-
Retention of skill
Monitoring of implementation and outcome and linking with routine
system
Cleaning of the Equipment
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Sabina Yasmin with her baby who was
resuscitated with bag & mask on 23rd
November at Mohammadpur UHC.
Dr Subol Chandra Borman , RMOresuscitating a newborn baby at Jointapur
UHC on 7th December.
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