Systems strengthening for quality MNH service data management:

Experience from 4 pilot hospitals

Global Maternal Health Conference Arusha, Tanzania; 16, Jan 2013

Dr. Nancy A. Kidula

Snr. RH/FP Advisor

Jhpiego Kenya

The problem

While Kenya does have a strong HMIS, indicators collected on MNH at the facility level are limited

data is often incomplete, inaccurate,

reporting is poor- Some indicators not captured

data is rarely available for use in planning

lack of data limits MNH service availability and quality

“Improvement of MNH data management and utilisation” is the top priority of the Kenya MNH Road Map (August 2010)

Testing a solution

USAID MCHIP is partnering with DRH/MOPHS

to pilot an MNH surveillance system in Kenya

GOK/DRH

M-CHIP MNH Surveillance

Step 1: Advocating for change

1. USAID - MCHIP Kenya sought concurrence from DRH/MOPHS for the pilot

2. Site Selection

Used based on predefined criteria

Four public district Hospitals selected

3. Baseline Survey done to assess facility readiness and situation analysis

Map with sites circled

Results of Baseline Survey

Different versions of MNH data tools in use

Data recording / capturing was inconsistent, incomplete

MOH designated codes were rarely used

Use of the partograph in labour was poor

Health service providers in all facilities

had not received any updates or in-service

training in the BEmONC

National MNH guidelines not available

at point of use

BEmONC equipment sets were incomplete or missing; supplies were lacking or not

available at point of use

Data was rarely utilised at facility level for for

decision making

Common situation- before intervention

Step 2: Capacity Building

Workshop

• 3 days

• 5 people from each facility

• Administrator, Nursing officer in charge, Maternity in-charge, Medical records, midwife

• Introduced importance of data management

• How to generate data

• Practicum: Shared their data sets and challenges

Site Visits

• Participants identified site specific problems

• Participants identified areas that did not require project help

• Procurement of basic supplies;

• reorganisation of services;

• maternal and perinatal death audits,

• communication etc;

Onsite Interventions

• Training:

• Data management and use

• Service skill updates in key MNH interventions

• e.g., Pre-eclampsia, neo-natal resuscitation, etc.

• Tools

• Job aids, guidelines, policies

• Data collection tools (sup. Register, data use wkbk,

Supportive supervision and

mentorship

• Weekly visits from the MCHIP/MOH team

• Worked with all clinical staff

• Observation and on-job coaching

• Feedback sessions and discussion

• Training on MNH skills

• Monthly Data Supervision visits

• Worked with records personnel and nurses

• Reviewed reporting tools

• Audited summary tools

Results:

Outputs: At least 60 health workers

have been updated in EmONC skills and in data management

Procured basic equipment and supplied

Reorganized work flow

Outcomes:

More complete and accurate reporting of MNH indicators including the partograph use

Data is being used at the facilities for decision making- MDR; timely referrals, partograph

Well and fully completed partograph

Box with emergency supplies for management of ecclampsia ready for use in the labour ward

Maternity Registers appropriately & well filled

Data Reporting and presentation enhanced; facilitates interpretation and use

Impact

? Reduced Maternal and Perinatal Morbidity and Mortality

Quotes from the field

“We were practicing witchcraft before the

HBB training.” (Dr at Makindu Hospital)

“The updates have really helped us . some of us are retiring and had never been

updated. You are removing us from mud.” (Matron at Gilgil Hospital)

“ As nurses we feared magnesium sulphate but

now we can use it and save lives.”

(Nurse-in-charge Makindu maternity)

Key Insights

Numbers alone are not useful – they have to

be good numbers

What makes a GOOD number?

Common definition of what the indicator is

attempting to capture

Everybody is counting the same thing in the

same way

E.g. Asphyxia and resuscitation

Conclusion

For an effective MNH surveillance system, data management skills building MUST BE accompanied by:

1. Clinical skills standardization &

2. Systems strengthening

Acknowledgements

DRH/MOPHS- Kenya

Administration and Staff of Naivasha, Makindu, Gilgil and Kangundo Hospitals

USAID MCHIP- Washington- Barbara and Maya

USAID MCHIP Kenya team

Jhpiego Kenya Thank you all for listening

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