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Maternal and Child Health Integrated Program (MCHIP) Saving Mothers Giving Life (SMGL) Baseline Facility Assessment - MANSA Date: 5TH TO 16TH December 2011 Location: Mansa District – Luapula Province Facilitators: NAME DESIGNATION ORGANIZATION 1 Martha Ndhlovu MCHIP - TECHNICAL ADVISOR Jhpiego – LUSAKA 2 Brenda Mubita MCHIP – TECHNICAL OFFICER Jhpiego - LUSAKA 3 Christopher Sinyinza Management Specialist ZSSP – MANSA 4 Timothy SILWEYA Community Health Coordinator ZSSP- MANSA 5 MERCY KANSWATA ACT. SR. IN CHARGE -CENTRAL CLINIC MANSA DHMT 6 FRIDAH Simbala PMCT/CT Technical Officer ZPCT II - MANSA 7 MELODY SHAWA Nursing officer - MCH MANSA DHO 8 JANE CHISANGA EMONC TRAINER RONALD ROSS HOSPITAL - MUFULIRA Introduction In December of 2011, a team of eight officers (two from MCHIP; two from ZSSP; two from Mansa DHMT; One EMONC trainer from Mufulira and One from ZPCT II) visited 30 sites in Mansa district to conduct baseline facility assessment on the Saving mothers giving life program. The assessment took place in all the 30 facilities in Mansa District. Due to heavy rains and bad roads, it took a bit long to get to and from some far off sites; however the teams were determined to finish the exercise. The baseline assessment will help in better planning of MCHIP activities to be undertaken in the district Approach Courtesy calls were paid to the PMO Dr. Bwalya and the Acting DMO Mr. Banda. The team was given the blessing of both the province and the district health office. An orientation meeting was held to orient the other team members on the assessment tool. The team formed three groups of two and one group had three people. The DHMT staff were interchanging as and when work demanded their attention in the office. The team had three vehicles (ZPCT, ZSSP and Jhpiego) which made the work easier and manageable. Each team visited at least two centres per day. The SMGL baseline facility assessment tool, version 8 was used. 1 Maternal and Child Health Integrated Program (MCHIP) At the end of the assessment, the DMO and his staff with partners (MCHIP,ZPCTII, ZISSP, SFH) did the action planning. Based on the assessment that was done and other needs which were identified. A Kalomo draft was used to develop the action plan. What has been attached is a draft and not final copy. Findings and challenges 1. Dedicated staff manning the centres despite the numerous challenges both at the hospital and the health centres MANSA GENERAL HOSPITAL 1. Mansa General Hospital is the only CMONC site in the district 2. It was a great challenge to collect data from the hospital. Some of the statistics had to be obtained from the district DMO 1. The DHO has a cell phone which is paged in case an ambulance is needed which the staff said was very helpful 2. Human resource in most centres is a big challenges due to inadequate accommodation 3. Conduct EMONC trainings for all staff in delivery centres 4. DHMT to think of strengthening the establishment of gardens and other ventures to grow vegetables. Clinics need to take stock of the inflow of clients to be able to cost Facility 1. Generally the documentation in the registers is good, though there are some inconsistencies 2. Resuscitation equipment not available in most centres 3. In some health centres staff do not look after equipment well. IP needs to be strengthened 4. Some centres do not have adequate delivery equipment 5. Radio system not functional in most centres. Need maintenance and batteries 6. In most centres protocols and guidelines are not displayed 7. Protocals of new born care, safe motherhood, PAC were not found in all centres 8. Quite a number of fresh still births were breech deliveries. As a result most centres now refer to hospital all breech presentations 9. Thirteen health centres have no electricity. Delivering in the dark mostly with a candle has been a challenge for all health care workers 10. Bat infestation in some centers is posing a serious health hazard to the clients especially the new born. 2 Maternal and Child Health Integrated Program (MCHIP) 11. Most health care providers complained that most pregnant women take African herbs as soon as they go into labor. Despite educating them, the practice is still high. This has also increased the number of still births 12. A number of staff have not been trained in EMONC in most delivery centres 13. Most delivery centres are using wards as delivery rooms. These are interchanged with other services posing danger of infections to the mother and baby 14. The few centres with mothers’ shelters are just improvised and being used by those waiting for their patients. 15. About four centers, providers have to walk more than four kilometers to find network 16. In few centres where providers are trained in EMONC they do not have equipment such as MVA kits 17. Some centres do not document the causes of fresh still births Community 1. All centres have SMAGS, NHCs, TBAs committees who encourage women to deliver at health centres 2. There seems to be a good relationship between the health centres and the local traditional leaders 3. Most feeder roads from the communities to health centre are not designed to allow the size of the bicycle or motorcycle ambulances to pass 4. Inadequate availability of bicycle and motor cycle ambulances to SMAGS to enable pregnant women to be brought to the centres 5. Mothers waiting to deliver complained that they have no food as they wait to deliver Observations (EmONC trained) • Ten (10) trained participants were not found on duty. Others were on leave and others attending some workshops and two are not practicing • Nine were found and mid course questionnaire was administered STAFF LEVELS – MANSA DISTRICT DOCS RN/RM RN EN EN/EM CO ML CERT. EHT MIDWIVES 18 13 55 70 25 25 1 5 29 3 Maternal and Child Health Integrated Program (MCHIP) STAFF LEVELS – MANSA DISTRICT (see annex 2) Total numbers of skilled providers working in labor ward or otherwise routinely responsible for conducting deliveries = 52+ (many trained EmONC providers were not found on site and so their skill level and need for re-training could not be assessed during this activity.) Recommendations and Next Steps • Need for constant maintenance and repairs of the structures to ensure bats are kept away • Provide solar panels to give light. In the interim provide lamps using dry cells (ordinary) • Intensify BCC (CSH) through SMAGS and local traditional leaders to educate the communities on dangers of African herbs • Engage leaders on the issue of community participation to expand the feeder roads (CSH) • Taking inventory of equipment in all facilities and re distribute to needy centres • There is need to ensure providers have some airtime to be able to page the hospitals • Liaise with MTN, Airtel and CellZ to expand to these far flung areas • Encourage staff through mentorship to document the causes of fresh still births • Refreshen induction on the use of the solar 4 Maternal and Child Health Integrated Program (MCHIP) ANNEX 1: Facility Information No. of Trained No of Deliveries Fresh Still Facility Type Site Status MSB VEND* EmONC Providers in Last 12 months Births 1 Mansa Central Clinic Urban Health Nil Not a delivery site but NIL 0 Centre attend emergency deliveries only 2 Kasoma Lwela Rural Health Centre Nil Delivery site 61 2 3 Chembe Health Rural Health Centre 1- but not found at Delivery site 246 7 all breech 3 Centre site 4 Lua Mfumu RHC ZNS Camp clinic 1 – not found on Delivery site 113 1 site 5 Kansenga RHC Rural Health Centre Nil Delivery site 30 1 0 6 Nsonga RHC Rural health Centre 1 (58%) Delivery site 65 1 Prematurity 7 Mano RHC Rural Health Centre Nil Delivery site 45 1 0 0 8 Chisembe RHC Rural Health Centre Nil Delivery site 32 0 0 0 9 Chisunka RHC Rural Health Centre Nil Delivery site 140 1 0 0 10 Muwan’guni RHC Rural Health Centre Nil Delivery site 168 8 (5 breech) 2 11 Chipete RHC Rural Health Centre Nil Delivery site 71 1 2 0 12 Fimpulu RHC Rural Heath Centre 1 (48%) Delivery site 110 3 (2 breech) 1 0 13 Senama health Urban Centre 1 (on leave) Delivery site 645 1 4 0 Centre 5 Maternal and Child Health Integrated Program (MCHIP) 14 Buntungwa HC Urban Centre 1 (on leave) Not delivery site 0 0 0 0 15 Mansa General General Hospital 4(non found) Delivery site 2070 84 54 0 Hospital 16 Moloshi RHC Rural Health Centre 0 Delivery site 68 2 1 0 17 Kalyongo RHC Rural Health Centre 0 Delivery site 141 3 0 0 18 Lubende RHC Rural Health Centre nil Delivery site 114 1 3 0 19 Kabunda RHC Rural Health Centre Nil Delivery site 113 0 0 0 20 Ndoba RHC Rural Health Centre 1 (68%) Delivery site 184 2 0 1 21 Matanda RHC Rural Health Centre 1 (52%) Delivery site 148 4 2 0 22 Paul Mambilima Rural Health Centre 1 (45%) Delivery site 90 1 1 0 23 Mabumba Rural Health Centre Nil Delivery site 186 1 1 0 24 Katangwe Rural Health Centre nil Delivery site 11 1 (by TBA) 0 0 25 Mantumbusa Rural Health Centre Nil Delivery site 49 1 1 0 26 Kalaba Rural Health Centre 1 (50%) Delivery site 231 1 0 0 27 Mutiti Rural Health Centre 1 (not found) Delivery site 100 3 (asphyxia) 1 0 delivered by TBA, CDE & EHT 28 Lukola RHC Rural Health Centre Nil Delivery site 83 3 0 0 29 Mibenge RHC Rural Health Centre 1 (67%) Delivery site 141 3 0 2 30 Kundamfumu Rural Health Centre 1 (63%) Delivery site 178 3 1 0 6 Maternal and Child Health Integrated Program (MCHIP) DHO DHO 1 (67%) *VEND – Very early neonatal death ANNEX 2: Number of Staff FACILITY DOCS RN/RM RN EN EN/EM C/O ML CERTIFIED EHT Anasthet Lab tec Tutors C/instr CDEs MIDWIFE ist uctor 1 Mansa General 18 6 38 44 10 14 1 3 (on 3
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