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Care for the Small & Sick Newborn Community of Practice Webinar

Implementation lessons from improving care for small and sick newborns in health facilities

David GatharaAssistant Professor of Health Systems

NEST360 Health Systems LeadLondon School of Hygiene and Tropical Medicine

National partnership for SSNC in Kenya

• Ministry of Health leadership – Division of Neonatal and Child health

• NEST network linkage with academic and professional institutions

• Network of hospitals

• National Newborn Committee of Experts convened• Validation of newborn protocols, aligned to WHO Standards

• Oversight of pre-service and in-service training

• Continuing Medical Education through webinars – multi-disciplinary team

• Joint operationalisation of regular hospital QI visits

NEST360 Overview – What are we doing?

NEST Bundle of Technologies

1. Radiant warmer2. Suction machine3. Oxygen concentrator4. Pulse oximeter

5. CPAP6. Oxygen splitter 7. Phototherapy lights8. Glucometer + strips

+ Maintenance kit

Health Systems Package

Implementation support:

• National policy change

• Data tools/systems, data use

• Investment case

Clinical & Technical:

• Pre-Service Education

• In-Service Education

• Supervision & Mentorship

Devices:

• Distribution and post

sales support

• Financing options

Rigorous “complex” evaluation of impact and cost

Implementation research with active learning and use of data

QI

Infrastructural improvements

• Multidisciplinary infrastructural improvement team input on model NBU blue-print layout

• Government County-led renovations supported by the NEST Kenya team

• Pre-implementation assessment with Go or No-Go yet criteria

Contextualising and consolidating learning

Adapted modules were presented to 118 people including;o Univ of Nairobi Paediatrics postgraduate studentso CIN focal persons (16 county hospitals, Nurses + paediatricians)o ETAT+ GIC instructorso Neonatal Nurseso Technical Working Group

Integrating NEST within national package for ETAT+

Delivering care with a constrained workforce –implications on quality and staff well-being

Nurses responsible for delivering most of the interventions in the newborn units

Nurse burnout

Adapting training approaches in pandemic

1. Pre-service training• Skills-lab

2. In-service training • Hands on training with

newborn devices

Practical-based training for clinical and bio-medical staff

Train bio-medical engineers on preventive and corrective maintenance

Threat… and an

opportunity

Implementation learning for Human Resources for Health

Opportunities

• Role of task-sharing/shifting

• Integrating technical training into clinical pre-service training

• Joint training of clinical with biomed technical staff – enhance

team work

• Evidence for optimal staffing ratios

• Investment case for MNH HR

AdmissionsDeaths

Care pathways

Health system inputs

Sustaining change • Facility level: Ongoing QI to

support/address challenges, linked to local data dashboards

• Multi facility networks: Learning collaborative highlighting successes and areas requiring improvement

• Community of practice for newborncare (neonatologists, paediatricians, nurses, biomedical engineers) via WhatsApp – sharing lessons

BEYOND SINGLE INTERVENTIONS and ‘ONE AT A TIME APPROACHES

Implementing quality care using a health systems approach –people centred, family centred care at the heart

8 Standards Collating practical resources, tools and active learning for

small & sick newborn care in low & middle income settings.

Addressing priority health system bottlenecks. eg floor plans,

data tools, device maintenance checklists

Human Resources- HSBB Group

23rd JUNE 2021 12.30 – 2 PM GMT !!!

Implementation Toolkit

for Small and Sick Newborn Care

WELCOME ALL!

Email: Zoe.Griffiths@lshtm.ac.ukDavid.Gathara1@lshtm.ac.uk