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Quarterly Report October – December 2007: 1St Quarter FY08

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Quarterly Report October – December 2007: 1St Quarter FY08 Quarterly Report October – December 2007: 1st Quarter FY08 This Project NOVA Quarterly Report describes the results of NOVA’s programmatic activities during the period of October 1 – December 31, 2007. Project NOVA is in full-scale implementation of all marz-level and national-level interventions in Armenia in accordance with its Statement of Work and FY08 workplan. AREA 1: Improve RH/FP/MCH Performance of Select Networks Tangible Result: Providers’ knowledge and skills improved . In October Project NOVA conducted two newborn care training courses for 26 practicing obstetrician/gynecologists, neonatologists, pediatricians, anesthesiologists, nurses, and midwives as part of its Comprehensive Maternal and Child Health (MCH) training package. During a three-day Newborn Care and Resuscitation training course at Vedi Maternity, trainers used an interactive learning and teaching methodology allowing learners to actively participate in the presentations and discussions. The participants also practiced their newly-acquired clinical skills on anatomical mannequins. The two-day training on the management of newborn diseases was organized at the Institute for Perinatology, Obstetrics and Gynecology for practicing neonatologists from Project- supported health networks. During this training the participants visited the Newborn Intensive Care Department and familiarized themselves with the new equipment and techniques for the care of sick babies. Pre- and post-knowledge evaluation tests measured the effectiveness of these training events. On average, participants’ knowledge increased by 50% from 36.5% at baseline to 86.5% at the end of the training (See Attachment B for more details on NOVA’s training events during this quarter). Training Courses Conducted by Project NOVA as part of Comprehensive MCH Training Package during October - December 2007 Training Course Network Number of Pre- Post- Knowledge participants test test Change Newborn Care Vedi 18 28% 78% 50% Management of Newborn Diseases All 8 45% 95% 50% TOTAL 26 36.5% 86.5% 50% . Training on newborn care completes the series of training interventions conducted by Project NOVA in its five selected health networks. As a result of the training activities, on average the providers’ knowledge increased by 38%: with the highest increases reported in the specific technical areas of infection prevention (45%) and newborn resuscitation and care (43%); and overall in Vedi (42%) and Talin (40%) (See table below). Project NOVA Quarterly Report 1 of 17 October – December 2007 Overall Knowledge Increase Among Healthcare Workers Following Project NOVA Training Courses Disaggregated by Technical Areas and Health Networks Training Course Vedi Talin Armavir Vayk Sisian TOTAL Newborn Care 50% 40% 37% 43% 47% 43% ANC/PPC 36% 42% 39% 32% 12% 32% Infant Care 33% 37% 32%, 33% 27% 21% 30% IP 46%,55% 24%, 54% 51%, 40% 47% 43%, 47% 45% EmOC 30% 40% 33% 30% 23% 31% OVERALL 42% 40% 38% 36% 32% 38% . On October 2 Project staff launched its flagship Safe Motherhood Clinical Skills (SMCS) training courses for 102 community nurses from the five Project-supported health networks in the south (See table below). This self-paced performance-based training consists of eight modules carried out over the course of six to nine months. During this reporting quarter in preparation for the training events, Project NOVA revised and updated Modules 3, 6, 7 and Job Aids based on the state-of-the-art information in these technical areas. Module 7 revisions also incorporated a new section on gender issues and the role of the community nurse in addressing domestic violence and gender-related discrepancies in accessing health care in the community. Using updated versions of the modules, community nurses successfully completed Module 1-3 on the basics of nursing; infection prevention; and antenatal care (See Attachment B for details). Health Post Community Nurses Enrolled into NOVA’s SMCS Training Network Marz Number of Coverage Nurses Talin Aragatsotn 35 34 of 93 Health Posts in Aragatsotn; 37% coverage Armavir Armavir 13 13 of 43Health Posts in Armavir; 30% coverage Vedi Ararat 14 14 of 45 Health Posts in Ararat; 31% coverage Vayk Vayots Dzor 15 15 of 37 Health Posts in Vayots Dzor; 41% coverage Sisian Syunik 25 22 of 99 Health Posts in Syunik; 22% coverage TOTAL 102 32% coverage . In October Project NOVA conducted follow-up visits to 1) monitor key MCH practices introduced and/or enhanced during the Comprehensive MCH training courses and 2) speed up their integration into routine medical practice. Results of the follow-up visits revealed that although some technical areas still need improvement, overall newly-trained healthcare providers adhere to what they have learned with NOVA. All NOVA-supported facilities that deliver babies practice active management of the third stage of labor, but routine use of the partogram during labor continues to be a challenge due to the absence of a regulatory order from the Ministry of Health. In the area of newborn and infant care, healthcare providers typically use the newly learned approaches and principles, including the proper treatment of umbilicus, the initiation of breastfeeding within the first hour of birth, maintaining the newborn warm chain, offering breastfeeding counseling and information on infant and newborn health danger signs, and adhering to the principles of Project NOVA Quarterly Report 2 of 17 October – December 2007 IMCI. However, most of the babies continued to be tightly swaddled. Project NOVA will continue its training follow-up visits to assist newly trained healthcare providers in the integration of acquired clinical knowledge and skills. Tangible Result: Training capacity strengthened . Project NOVA continues the implementation and monitoring of the pre-service nursing and midwifery training pilot initiative at the Gyumri Medical College. While Gyumri Medical College faculty members implement the pilot using newly-developed training curriculum, syllabus and methodology, Project NOVA conducts routine monitoring visits to the college. NOVA monitors to what extent the faculty members adhere to the content of the syllabus; what problems/discrepancies have been observed related to the course syllabus; to what extent does the faculty adhere to the timing, class agenda and session objectives; and do they use audiovisual materials, mannequins and interactive techniques. Monitoring visits revealed that overall faculty members adhere to the content and syllabus and routinely use audiovisual material and interactive training methodology. However training rooms themselves are small and inconvenient for classroom training. While the faculty is making strides to improve the quality of teaching, much work remains to be done to achieve the desired level. One of the main challenges to quality pre- service teaching is the discordance between the number of students and available resources and conditions (number of trainers, rooms for clinical practice in hospitals etc.) which go beyond NOVA’s scope of work under this initiative due to limited financial and human resources. Tangible Result: Healthcare facilities equipped and renovated . The renovations in Talin Medical Center Children’s Polyclinic and Sisian Medical Center Maternity Ward were successfully completed in November 2007. The official opening ceremony took place in Sisian on December 13 and in Talin on December 20. Coupled with better trained healthcare workers and available basic equipment, supplies and furniture provided by NOVA, renovated healthcare facilities will significantly improve overall quality of MCH services offered to the rural population. These improvements will increase utilization of services, including immunization of children under five, antenatal care and postpartum care. Medical Centers Renovated by Project NOVA (updated) HEALTHCARE FACILITY (MARZ) RENOVATION BUDGET TOTAL (AMD) NOVA Other Talin Medical Center Children’s Polyclinic (Aragatsotn Marz) 10 034 127 64% 34% Sisian Medical Center Maternity Ward (Syunik Marz) 5 265 680 100% 0% AREA 2: Strengthen Management and Supervision Tangible Result: Quality assurance system at Hospitals introduced . Project NOVA conducted three Marz Advisory Board meetings: in Sisian on December 13, in Artashat on December 11, and in Armavir on December 26. Meeting attendees included Project NOVA staff, health department authorities, and representatives from respective clinical training sites and local NGOs. Participants discussed the issues Project NOVA Quarterly Report 3 of 17 October – December 2007 pertaining to the implementation pace of Project NOVA clinical training events; outcomes of Quality Assurance Team activities, including the results of self-assessments; dissemination and presentation of NOVA’s health education materials in rural communities and the clinical setting; and the current and future status of the Community Partnership for Health (CPH). The Project continues the implementation of its Quality Assurance (QA) activities. As part of this initiative, QA team members at two sites completed their third self-assessment which demonstrated small but tangible achievements across all dimensions (See table below). All sites established and use suggestion boxes for patients’ feedback; team members received and use infection prevention protocols; and sites have assigned rooms for the School of Motherhood and posted signboards with healthcare facilities working hours. All QA teams are working to solve the remaining problems identified in their
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