F-IMNCI Case Study
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F-IMNCI Case Study Southern Shan State MCSP Child Health Team 2016-2018 Acknowledgements The Maternal and Child Survival Program (MCSP) is a global United States Agency for International Development (USAID) initiative to introduce and support high-impact health interventions in 25 priority countries to help prevent child and maternal deaths. MCSP supports programming in maternal, newborn and child health, immunization, family planning and reproductive health, nutrition, health system strengthening, water/sanitation/ hygiene, malaria control, prevention of mother to child transmission of HIV, and Pediatric HIV care and treatment. MCSP tackles these issues through approaches that also focus on household and community mobilization, gender integration and digital health, among others. In Myanmar, under the leadership and direction of the Child Health Development Division (CHD) and the support of pediatricians, neonatologists of Yangon Children's Hospital, Lashio General Hospital and Taunggyi Women and Children Hospital (WCH), MCSP collaborated with the MOHS in organizing F-IMNCI training to the health staff in hospitals of Southern Shan State. With the support of the State Health Department and clinicians in Taunggyi WCH, MCSP supported the post-training supervision and follow-up to the trained heath staff and assessed the hospital infrastructure. This report is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents of this report are the responsibility of the Maternal and Child Survival Program and do not necessarily reflect the views of USAID or the United States Government. July 2018 Cover Photo: Dr Thein Thein Hnin, Professor Neonatologist of Taunggyi Women and Children Hospital, demonstrating Intraosseous cannulation in the F-IMNCI training, Taunggyi, Southern Shan State, November 2017 Contents Page Figures........................................................................................................................................ 3 Abbreviations ............................................................................................................................. 4 1. Background ............................................................................................................................ 5 1.1 Global and Country situation ........................................................................................... 5 1.2 Goals and Objectives ........................................................................................................ 6 1.3 Overview of the intervention............................................................................................ 6 2. Methodology .......................................................................................................................... 8 2.1 Implementation Process ................................................................................................... 8 2.1.1 Coordination .............................................................................................................. 8 2.1.2 Training ..................................................................................................................... 8 2.1.3 Learning and Performance Improvement Center(L&PIC) ...................................... 12 2.1.4 Post-training supervision ......................................................................................... 13 2.1.5 End of Project .......................................................................................................... 14 3. Results .................................................................................................................................. 15 3.1 Quantitative and Qualitative findings ............................................................................ 15 3.1.1 Pre- and Post-test results in F-IMNCI training ........................................................ 15 3.1.2 Post-training supervision visits ................................................................................ 15 3.1.2.1 Knowledge assessment test findings ................................................................. 15 3.1.2.2 Case scenarios finding (6 OSCEs) .................................................................... 16 3.1.2.3 Supervision of hospital infrastructure .............................................................. 20 3.1.2.3.1 General assessment .................................................................................... 20 3.1.2.3.2 Emergency or Outpatient Department (OPD) ............................................ 21 3.1.2.3.3 Labor room and postnatal ward .................................................................. 21 3.1.2.3.4 Child Ward ................................................................................................. 22 3.1.2.3.5 Laboratory .................................................................................................. 23 3.1.2.3.6 Equipment .................................................................................................. 23 3.1.2.3.7 Human resources ........................................................................................ 24 3.1.2.3.8 Drug and Pharmacy .................................................................................... 24 3.1.2.3.9 Clinical practice and guidelines ................................................................. 24 4.Analysis................................................................................................................................. 25 4.1 Challenges ...................................................................................................................... 25 4.1.1 Training ................................................................................................................... 25 1 4.1.2 Post-training supervision ......................................................................................... 26 4.2 Lessons Learned ............................................................................................................. 27 4.3 Best Practices ................................................................................................................. 28 4.4 Recommendations .......................................................................................................... 28 4.4.1 Planning ................................................................................................................... 28 4.4.2 Training ................................................................................................................... 28 4.4.3 Post-training supervision ......................................................................................... 28 4.4.4 Hospital Infrastructure ............................................................................................ 28 4.4.5 Future planning ........................................................................................................ 29 5. References ............................................................................................................................ 29 6. Annexes................................................................................................................................ 31 Annex 1. Number and percentage of hospital staff reached through F-IMNCI training and supervision ................................................................................................................30 Annex 2. Participants in training and supervision............................................................30 Annex 3. Hospital participation in training and supervision............................................31 Annex 4. Pre- and Post-test scores of participants during training...................................32 Annex 5. Achievement scores of 94 participants in six OSCEs in first supervision visit…..32 Annex 6. Average scores of supervised hospital staff during the post-training supervision visits (6 OSCEs)................................................................................................................32 Annex 7. Multiple choice questions and answers used in Pre and post test of training and during supervision (20 MCQs).........................................................................................33 Annex 8. Six OSCEs checklist used for skill assessment in supervision.........................37 Annex 9. Hospital assessment forms (3 groups)..............................................................47 Annex 10. Revised hospital assessment form recommended to use for future assessment in township hospital..........................................................................................................72 Annex 11. F-IMNCI training materials............................................................................91 7. Success story........................................................................................................................93 2 Figures Figure 1. Under 5, Infant and Neonatal mortality rates in Myanmar Figure 2. Pre- and Post-test average scores of participants inF-IMNCI trainings Figure 3. Number of health staff by achievement scores (6 OSCEs) Figure 4. Number of medical doctors by achievement scores (6 OSCEs) N=17 Figure 5. Number of nurses by achievement scores (6 OSCEs) N=77 Figure 6. Percentage of medical doctors and nurses by achievement