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MCSP Guinea Restoration of Health Services, March 2017

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MCSP Guinea Restoration of Health Services, March 2017 MCSP Guinea Restoration of Health Services, March 2017 MCSP/Rachel Waxman Guinea–Selected Demographic and Health Indicators Indicator Data Indicator Data Indicator Data TFR (births per Population (1) 10,628,972 5.1 Pneumonia (2) 38% woman) (2) CPR (modern 36.5% / Live births/year (3) 368,558 5% ORS / Zinc (2) methods) (2) 0.5% Ebola infections MMR (per 100,000 724 ANC +4 (2) 56.6% during recent 3,804 live births) (2) epidemic (4) Ebola death rate NMR (per 1,000 live (percentage of 34 SBA (2) 45.3% 66% births) (2) infections ending in death)(4) U5MR (per 1,000 live 94 DTP3 (3) 51% births) (2) Sources: (1) 2014 National Census; (2) DHS 2012; (3) WHO UNICEF 2015 coverage estimate; (4) WHO Ebola Situation Report, December 2015. Strategic Objectives: Restoration of Health Services Program At least 80% of MCSP-supported hospitals and health centers (n=221) meet minimum IPC standards. 34 facilities supported to reinvigorate and maintain the SBM-R process, with at least 80% achieving and/or maintaining recognition of performance. 75% of target facilities in the 20 focus prefectures have increased capacity to offer RMNCH services (of 26 hospitals and 195 health centers). 96 health posts supported to improve IMNCI and contribute to the care of sick children in the catchment areas of 30 health centers (revised target). 700 community health workers (ASC) are supported to reinvigorate community health and mobilization to provide health information, accompaniment of pregnant women, and FP services, as well as key lifesaving interventions; and to increase community ownership and capacity to explore, plan, and act together for improved RMNCH outcomes in communities surrounding 20 MCSP-supported health centers. Program Dates July 14, 2015–December 17, 2016 (18 months) Financial Total budget = _____ Summary Geographic National; Regions of Boké, Conakry, Forécariah, Kindia, N’Zérékoré (plus Kissidougou Scope prefecture) No. of No. of provinces (%) No. of districts (%) facilities/communities (%) Geographic 26 of 44 (68%) hospitals/CMCs Presence 4 of 8 regions (50%) 20 of 38 prefectures (53%) 195 of 404 (48%) health (7,647,281 population) centers Technical Interventions PRIMARY: Maternal Health, Newborn Health, Child Health, Reproductive Health, WASH, Ebola CROSS-CUTTING: Community Health, SBCC, PSE Key Accomplishments The RHS program supported national and regional trainers who conducted coaching visits to facilities focused on IPC performance. This work followed IPC training provided under the earlier Ebola Response programs, which were also supported through MCSP. In addition, the RHS program supported the reinforcement and/or reestablishment of hygiene and safety committees that oversee internal supervision, stock management, and action planning for IPC. Performance scores improved in almost all facilities, with 45% of health facilities/services meeting the minimum desired performance of 75% of IPC standards. The behavior change required to maintain IPC performance, and the need to ensure adequate availability of commodities for IPC, are ongoing challenges in the effort to achieve consistent and correct performance of standard precautions, let alone more complex tasks needed to prevent and control potentially epidemic disease. MCSP observed some declines in IPC performance as prefectures were declared Ebola-free and the EVD epidemic was declared over in Guinea. The coaching visits worked to remediate some of this reduced performance, yet changing providers’ beliefs about the risks to themselves and their patients, as well as their habits in terms of IPC practices, remains a fundamental health systems challenge Health Centers Hospital Services Baseline Endline Baseline Endline Performance Score Evaluation Evaluation Evaluation Evaluation 165 % 165 % 174 % 174 % Score of 75% or higher 7 1% 60 36% 11 6% 91 52% Score of 50–74% 38 12% 68 41% 36 21% 44 25% Score of 25–49% 70 46% 34 21% 41 24% 21 12% Score of 0–24% 42 41 3 2% 77 44% 4 2% Not assessed 8 MCSP supported the rehabilitation of water storage and supply in service provision areas and solar energy supply for backup electricity in the key service provision areas of three hospitals. Twenty-three autoclaves were distributed to facilities to support correct instrument processing. In many cases, hospitals previously had been provided with large-capacity autoclaves that they could not operate on the available power supply; thus, smaller-capacity units were provided to better suit available conditions. Non-electric autoclaves were provided to health centers that did not have electricity but could obtain propane tanks to heat the unit. Before (left): Matrons have to collect water for the maternity. After: A bore hole with pump and filter have been installed with a new tank on a platform to distribute water into service provision areas. A large storage tank (right) and a reservoir were repaired to improve water availability even when the pump is not running. All 34 facilities using SBM-R were supported in their ongoing implementation of the SBM-R quality improvement approach. Although these facilities had been implementing SBM-R for several years before the Ebola epidemic, assessments at the beginning of the RHS program showed major declines compared to previous assessments. Thus RHS started by working with the internal SBM-R teams and prefectural and regional supervisors to reinvigorate the process, including orientation of new staff where needed. At the most recent assessment, nine facilities were performing at the recognition level, and nine had improved their performance but had not yet reached the recognition level. Of the 221 focus facilities, 84% received support to improve RMNCH (training, materials, supportive supervision), including the following clinical areas: BEmONC (171 HCs); CEmONC (26 hospitals); IMNCI (39 HCs and 114 health posts, 1 CMC and 1 pediatrics unit of the prefectural hospital); and PPFP integration (17 hospitals and HCs). This exceeds the target of 75% of facilities in focus areas. The inputs to these health facilities contributed to increases in the number of pregnant women who had an assisted delivery in a facility including those receiving active management of third stage labor for prevention of postpartum hemorrhage (see graphs below). The program had the flexibility to alter the objectives for IMNCI once it was determined that other health partners were supporting health centers and CHWs, yet a large number of sick child consultations were taking place at health posts that were largely unsupported. MCSP RHS extended training to health post staff in collaboration with the health centers they feed into, reaching mostly auxiliary health agents (ATSs) at 114 health posts. These inputs contributed to a 13% increase in health care seeking in three of the four regions and 29% increase in assisted deliveries in the two regions that experienced the largest numbers of EVD cases (see details by region in third graph below; Boké is excluded because MCSP did not cover the entire region). Figure 1: Evolution of number of assisted deliveries in the regions of Conakry and N’Zérékoré 57,080 60,000 50,000 44,226 40,000 35,881 30,000 21,764 22,462 21,199 20,000 10,000 0 Conakry region N'Zérékoré region Total Oct 14–Sept 15 Oct 15–Sept 16 Figure 2: Percentage of women delivering at a health facility who received active management of third stage of labor (AMTSL) 100% 96% 91% 91% 92% 80% 85% 60% 40% 20% 0% Oct - Dec 15 Jan - March 16 April - June 16 July - Sept 16 Oct- Dec 16 Figure 3: Evolution of patients seeking care at health facilities in the regions of Conakry, Kindia, and N’Zérékoré, 2015 and 2016 1,400,000 1,275,260 1,200,000 1,125,276 1,000,000 800,000 600,000 519,949 535,483 379,973 331,993 359,804 400,000 273,334 200,000 - Conakry Region Kindia Region N'Zerekore Region Total January - December 15 January - December 16 The program successfully introduced a new training methodology of onsite, individualized learning, which allowed more providers to acquire key skills in RMNCH. With the introduction of a module on PPFP/PPIUD integration into maternity and ANC services, 153 providers participated in training at 17 facilities, and to date 105 have completed training and skills qualification to date, 24 have completed the course and are awaiting qualification, and another 24 were continuing the individualized learning at the end of the program. A total of 975 CHWs (140% of target) were supported with education and information on maternal, newborn and child health to reinforce their capacity to provide community health services (755 in RMNCH and 220 in IMNCI). Community mobilization teams were established in eight districts of Boké and Kindia. Community mobilization activities help to strengthen the link between communities and health services and promote health care seeking when needed. MCSP RHS also supported the revision of the community education logbook/register used by CHWs to document activities that align with the key messages of the integrated community health package. Challenges After the Ebola outbreak was declared over, the program found that it was difficult to maintain good IPC practices such as hygiene, triage, and waste management. Coaching for IPC must be ongoing to bring about the required behavior change. Although the program has closed, support for IPC is still needed. MCSP RHS also dealt with a number of delays in planned activities when MOH staff were called to participate in various campaigns, such as vaccination days and LLIN distribution, which took all staff away from their other responsibilities, despite the program’s best efforts to support coordination of and preparation for these and routine activities. Way Forward Despite the challenges discussed above, MCSP RHS enjoyed strong MOH engagement in reinforcing IPC and revitalizing community health, as well as close collaboration with other partners and projects, including other USAID Ebola Recovery–funded projects such as HC3 and HFG.
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