Design And Planning Of Phcs
Design And Planning Of Phcs
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Objective 1:
To Improve the quality of intrapartum and postnatal care provided to refugees in Kule, Tierkidi, and Nguenyyiel Camps in Gambella, Ethiopia by 2021.
Activity # Activities Outputs Outcomes Disaggregation Assumptions
1.1 Provide ambulances for emergency transport of women in labor.
Increased number of ambulances Increased proportion of women who deliver in healthcare facilities
Per camp Refugee vs. non Rural vs. urban
Women do not deliver at healthcare facilities due to distance and lack of transportation; providing transport will increase facility deliveries and reduce maternal and neonatal mortality.
Indicators
Number of ambulances serving Gambella
– Proportion of women who deliver in healthcare facilities – Proportion of women who list distance or lack of transport as reason for home delivery
1.2 Provide motorcycles for midwives to access rural communities.
Increased number of motorcycles for use by healthcare personnel
– Increased proportion of women who deliver with a skilled birth attendant – Increased proportion of neonates with postnatal check within 48 hours
– Per camp – Refugee vs. non – Rural vs. urban
The low proportion of births with skilled attendants and neonates with 48-hr follow-ups is in part due to lack of access; increasing ability of SBAs to reach women in rural communities will increase SBA use, improve neonatal follow-up, and reduce maternal and neonatal mortality
Indicators
Number of motorcycles owned by health system
– Proportion of deliveries with a skilled birth attendant
20
– Proportion of neonates with postnatal check within 48 hours
1.3 Provide a kit of essential supplies to HEWs for community- based newborn care (CBNC) and basic hygiene.
Increased proportion of midwives with adequate supplies
Improved capacity for management of perinatal complications
– Per camp – Refugee vs. non – Rural vs. urban
A key component of quality of care is the inputs available for use. Improving inputs will improve quality.
Indicators
– Proportion of midwives with gloves, warming blankets, instruments for positive pressure ventilation, and appropriate antibiotics for neonatal infection on hand at audit – Proportion of midwives who report having adequate supplies to perform duties including CBNC
– Proportion of neonates who receive antibiotics within 6 hours of being diagnosed with infection – Proportion of neonates with respiratory compromise who receive PPV
1.4 Provide educational messages via mobile texts to expectant and recent mothers.
Increased awareness among expectant and recent mothers of evidence-based recommendations to promote infant health (e.g. signs of preeclampsia, use of SBAs, exclusive breastfeeding, vitamin supplementation, vaccinations, fever mgmt).
Design And Planning Of Phcs Assignment
– Incrseased proportion of expectant and recent mothers who seek care and support about infant’s health
– Per camp – Refugee vs. non – Rural vs. urban
Mother’s are in need of information about infants health and they have access to phone where mobiles texts could be sent to
Indicators
Proportion of mothers of children under 3 who are aware of each recommendation.
Proportion of mothers of children who: – exclusively breastfed for 1st 6 months – received age- appropriate vaccinations on schedule
20
– received recommended vitamin supplementation
1.5 Implement a system for patients to provide feedback to midwife supervisors via text.
Increased feedback to supervisors on midwife performance
Increased responsiveness of midwives to patients’ needs and preferences.
– Per camp – Refugee vs. non – Rural vs. urban
By providing feedback on performance, the system will incentivize midwives to provide better service. This will both improve quality of care and improve demand for SBA services, increasing utilization.
Indicators
Proportion of supervisors who report adequate feedback about midwives’ performance
– Proportion of mothers who report that midwife met a need – Proportion of mothers who report satisfaction with midwife’s service
1.6 Implement a system for midwives to report anonymized birth outcomes via text.
Increased information available to health system leaders on numbers and causes of neonatal morbidity and mortality.
– Per camp – Refugee vs. non – Rural vs. urban
Improving the capacity for monitoring of outcomes will enable health system leaders to identify problem areas and further improve system performance.
Indicators
Proportion of births with SBA present for which birth outcome is reported via text
Objective 2:
To improve the healthcare workforce capacity for refugee maternal and child health in Kule, Tierkidi, and Nguenyyiel Camps in Gambella, Ethiopia by 2021.
Activity # Activities Outputs Outcomes Disaggregation Assumptions Method of Data
1.1 Train new midwives and HEWs and re-train the existing staff on current standards
Increased number of MWs & HEWs available to the community
Increased number of attended birth and increased measure of preventative care measures.
Curative vs. preventive measures; gender of MWs & HEWs; age of MWs & HEWs;
By increasing the quantity of trained MWs and HEWs to the population, medical care will be more accessible and dealt with in a more preventive manner
MW & HEW registries at HC level; supervisor logs
Indicators
# of new MWs & HEWs trained per quarter
Proportion of births attended by skilled health worker.
Better ratio of preventive vs. curative measures; balance of age pyramid of MWs & HEWs
Logs of MWs and HEWs; types of medical supplies distributed
1.2 Train nurses and physicians to supervise and train midwives and HEWs
# of new supervisors in for MWs & HEWs
Improved skill base; better retention; ongoing training of new MWs & HEWs
Gender of supervisors; age of supervisors;
By increasing the engagement of MWs & HEWs through better supervision, skills will be improved, retention will increase, and the system will become self- sustaining
Supervisor, MW & HEW registries at HC level;
Indicators
Ratio of supervisors to MWs & HEWs
# of new HEWs & MWs trained by supervisors; increased patient satisfaction scores; increased
Balance of genders of supervisors. Design And Planning Of Phcs Assignment
20
tenure of MWs & HEWs
1.3 Provide ongoing quality of care reminders via mobile messaging to midwives and HEWs
# of messages sent to MWs & HEWs
Consistent level of care and better accomodation for updated standards; more rapid deployment of new knowledge
Breakdown by type of message; read receipts; geographical distribution of messages
By increasing the amount of knowledge received on an ongoing basis, quality of care will stay high without needs for ongoing and costly in-person training
Registry of messages sent from central service points or supervisor phones.
Indicators
# of messages sent and read per quarter
Decreased training costs; performance evaluation scores
Ratio of types of messages vs. types of health complaints in the population
Patient satisfaction surveys; supervisor assessments of MWs & HEWs
1.4 Train midwives in CBNC # of midwives trained on CBNC. Design And Planning Of Phcs Assignment
Better health outcomes for neonates; decrease in neonatal mortality
Health outcomes by level of training of HEWs; by geography
By training midwives in specific CBNC techniques, overall neonatal mortality will go down. The level of HC utilization will decrease but the outcomes will improve.
Midwife reports to supervisors
Indicators
Proportion of total midwives trained in CBNC.
Decreased proportion of neonatal mortality