This study will introduce a multi-faceted intervention package which will be implemented in the newly developed network of St. Paul's Hospital Millennium Medical College (St. Paul) and the surrounding seven satellite health centers. The goal is to assess if this group of interventions improve the skills and confidence of providers to handle obstetric emergencies, if they streamline the referral process and if they result in improved maternal/newborn health outcomes.
Study Type
INTERVENTIONAL
Allocation
NA
Masking
NONE
Enrollment
10,787
Health workers at the eight health centers will be trained in maternal, newborn, and child health (MNCH) care, including all basic emergency obstetric and neonatal care (BEmONC) signal functions and other essential MNCH services. The training is a three week competency-based curriculum developed recently by the Ethiopian Federal Ministry of Health (FMoH).
A key intervention will be the creation of an effective, formalized networking system between Saint Paul Millennium Hospital and its eight satellite health centers in Addis Ababa. The networking system will create a conducive environment for the transfer of knowledge and skills between health care providers working at the hospital and in the health centers. Monthly review meetings will bring together staff from the hospital and health centers, and dedicated cell phones will be distributed to improve communication between the networked facilities.
Addis Ketema Health Center
Addis Ketema Subcity, Woreda 4, Ethiopia
Woreda 7 Health Center
Addis Ketema Subcity, Woreda 9, Addis Ababa,, Ethiopia
Semen Health Center
Arada Sub City, Addis Ababa, Ethiopia
Selam Health Center
Gulele Sub City, Woreda 9, Addis Ababa, Ethiopia
Improved provider skill levels
Provider skill will be measured through baseline and endline evaluations, mentoring reports, and the standardized evaluations used in the Basic Emergency Obstetric Care trainings.
Time frame: One Year
Improved provider self-efficacy
Improved provider confidence will be assessed at baseline and at endline with a standardized data collection instrument.
Time frame: One Year
Increased use of effective interventions for obstetric emergencies
Continuous data extraction from patient charts will be used to assess the appropriate treatment for obstetric emergencies over the study period. Additionally changes in time-to-treatment for post-partum hemorrhage and pre-eclampsia/eclampsia cases will also be assessed from patient charts.
Time frame: One Year
Improved standards of care for pregnant women
Continuous extraction from patient records throughout the study period will be used to assess the trends in the Standards of Care (SOC) for Ante-natal (ANC), and care during Labor and Delivery.
Time frame: One Year
Improved Referral Systems
* Decreases the proportion of referrals made without proper prior communication to the receiving health facility * Formalized feedback mechanisms between Saint Paul and the Health Centers * Decreased number of inappropriate referrals from Health Centers to St. Paul * Appropriate back-referrals from St. Paul to Health Centers Data on Health Center/Hospital communication and referrals will be collected through phone logs, and referral sheets.
Time frame: One Year
Sustainable, continuous quality improvement cycles through supportive supervision
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At Saint Paul Millennium Hospital and the health centers, providers who have undergone BEmONC training will undergo regular monthly mentorship visits for the first six months post training. The frequency of visits after six months will be adjusted based on the retention of BEmONC skills and provider performance
Saint Paul Hospital will use team-based models to provide supportive supervision to health centers in its network. Representatives of the supportive supervision teams may, in addition to Saint Paul Hospital employees, include representatives from the Addis Ababa Regional Health Bureau.
Saint Paul Millennium Hospital's maternity wards are often over-crowded and have to turn patients away. Health professionals incorrectly refer non-complicated deliveries, resulting in the occupation of beds that should be used for emergency deliveries. This action is attributed to inexperienced midwives at the health center level who are uncomfortable performing normal labor and delivery duties. In order to address this challenge, this project will establish an exchange program in which well-trained, experienced midwives from the hospitals will temporarily exchange places with less-experienced midwives in the health centers. This exchange would allow less-experienced midwives to work in the hospital environment, gaining the experience and confidence necessary to attend normal deliveries and identify appropriate referrals.
Mechanisms and protocols for smooth communication between the health centers and the hospital have been developed, allowing health centers to utilize the hospital's ambulance, and implementing mechanisms for back referrals and feedback. To facilitate this work, we will support the use of dedicated cell phones in each of the eight networked facilities and at Saint Paul Millennium Hospital, and institute referral log books at both the referring and receiving institutions.
Facility checklists will be used daily in each of the facilities to assess readiness for obstetric emergencies. Formally, the checklists will be used at the quarterly supportive supervision visits, to assess improvements over time.
Non-punitive obstetric drills will provide multiple measurable indicators of quality maternal care, will illustrate opportunities for improving facility capabilities and provider care, and will allow providers to assess appropriate referral mechanisms and facility readiness. Incorporating emergency drills into current training and at all levels of health facilities will also give providers hands-on experience
St. Paul Hospital Millennium Medical College
Gulele Subcity, Addis Ababa, Ethiopia
Shegole Health Center
Gulele Subcity, Woreda 10, Addis Ababa, Ethiopia
Woreda 7 Health Center
Gulele Subcity, Woreda 7, Ethiopia
Kolfe Health center
Kolfe Sub City, Woreda 2, Addis Ababa, Ethiopia
Quarterly, a supportive supervision team will visit each of the health facilities involved in this study, and, using a checklist and a participatory approach, will identify areas to improve the quality of care provided. Each action item will will have a person assigned to it, and a plan to resolve the issue. Follow up supportive supervision visits will begin with an assessment of the previous visit's action plan, and then work to identify new areas for quality improvement. This process is iterative.
Time frame: One year