• USAID Aaternal and Child FROM THE AMERICAN PEOPLE / Survival Program South Africa End of Project Report June 2015–September 2019 Submitted on: September 30, 2019. Revision submitted January 10, 2020 Submitted to: United States Agency for International Development Cooperative Agreement #AID-OAA-A-14-00028 Submitted by: The Maternal and Child Survival Program www.mcsprogram.org The Maternal and Child Survival Program (MCSP) is a global, $560 million, 5-year cooperative agreement funded by the United States Agency for International Development (USAID) to introduce and support scale-up of high-impact health interventions among USAID’s 25 maternal and child health priority countries, as well as other countries. The program is focused on ensuring that all women, newborns and children most in need have equitable access to quality health care services to save lives. MCSP supports programming in maternal, newborn and child health, immunization, family planning and reproductive health, nutrition, health systems strengthening, water/sanitation/hygiene, malaria, prevention of mother-to-child transmission of HIV, and pediatric HIV care and treatment. This report is made possible by the generous support of the American people through USAID under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of MCSP and do not necessarily reflect the views of USAID or the United States Government. Table of Contents Acknowledgments ............................................................................................................. v Acronyms and Abbreviations .......................................................................................... vi Country Summary ........................................................................................................... vii Executive Summary ....................................................................................................... viii Introduction........................................................................................................................ 1 Major Accomplishments ................................................................................................... 3 Objective 1: Strengthen clinical leadership skills of newly appointed tertiary pediatric care nurses and other clinical care staff at the NMCH .............................................................................................................. 3 Objective 2: Support nursing management to strengthen practice management and governance, including systems, processes, and protocols at the NMCH ............................................................................... 6 Objective 3: Coordinate the establishment of a network in the Southern Africa Development Community among USAID-supported implementing partners, national referral hospitals, and nursing associations .................................................................................................................................................... 11 Recommendations and Way Forward .......................................................................... 12 MCSP South Africa End of Project Report iii iv MCSP South Africa End of Project Report Acknowledgments The Maternal and Child Survival Program (MCSP) is grateful to the support of many collaborators in South Africa, most especially the Nelson Mandala Children’s Hospital executive and nursing teams, including Dr. Mandisa Maholwana, CEO, and Jayson Gopiechand, nursing director, as well as all nursing unit leaders and nursing staff. MCSP is also grateful to the support provided by the Nelson Mandela Children’s Hospital Trust in envisioning this partnership and assisting with activities in the early days prior to the opening of the hospital. MCSP also greatly appreciates the warm support from the entire Johns Hopkins Health System, which identified and provided a diverse range of expertise to support the program. MCSP extends its thanks to USAID Southern Africa for its support of this project. The early assistance provided support to Nelson Mandela’s vision for ensuring that all children have access to the care they need, which is a guiding principal of the hospital and infused every aspect of this collaboration. MCSP also wishes to thank USAID Washington for their support and guidance during the life of the project. MCSP South Africa End of Project Report v Acronyms and Abbreviations ACH All Children’s Hospital CUSP Comprehensive unit-based safety program ECMO Extracorporeal membrane oxygenation JHCC Johns Hopkins Children’s Center JHI Johns Hopkins Medicine International MCSP Maternal and Child Survival Program NICU Neonatal intensive care unit NMCH Nelson Mandela Children’s Hospital NMCH Trust Nelson Mandela Children’s Hospital Trust PICU Pediatric intensive care unit USAID United States Agency for International Development vi MCSP South Africa End of Project Report Country Summary Geographic Implementation Areas Population Regions Country • Southern Africa, based in Johannesburg, • 56.72 Million South Africa Facilities MCSP -supported areas • Nelson Mandela Children’s Hospital (NMCH) • 13.2 Million Technical Areas: Child Health, Newborn Health, Health Systems Strengthening Program Dates Strategic Objectives Through the Life of Project June 2015–September 2019 • Strengthen clinical leadership skills of newly appointed tertiary pediatric care nurses and other clinical care staff at the NMCH • Cumulative Spending Support nursing management to strengthen practice management and Through Life of Project governance, including systems, processes and protocols at the NMCH • Coordinate the establishment of a network in the Southern Africa $2,250,000 Development Community among United States Agency for International Development-supported implementing partners, national referral hospitals, Demographic and Health and nursing associations Indicators Highlights Through the Life of Project Indicator # or % • Construction on the NMCH broke ground in 2014 Number of • In 2015, MCSP began working with the NMCH Trust to plan for the specialty development of a robust, highly skilled pediatric specialty nursing program, pediatric 4 with assistance from Johns Hopkins Medicine through the Johns Hopkins hospitals in Sub- Children’s Center and the Johns Hopkins All Children’s Hospital Saharan Africa • In December 2016, the hospital officially launched and the first outpatients 35 were received in June 2017 deaths • MCSP and its subpartner Johns Hopkins Medicine International provided Infant mortality per technical support to the nursing program throughout the planning and rate (South 1,000 opening of NMCH, including assisting with development of nursing policies, Africa)1 live standard operating procedures, interdisciplinary teams, and unit readiness births • MCSP assisted in the opening of each service unit through onsite training or skills-building exchanges for nurses, and remote follow-up • As the hospital scaled up its services, MCSP provided ongoing technical Under 5 assistance to the nurse managers to address quality, operational, and mortality rate management support needs (South Africa)1 • As of March 2019, NMCH had a nursing compliment of 91 professional nurses, 15 enrolled nurses, and 14 nursing assistants and had provided care to 1,999 outpatient clients and 1,354 inpatient clients Sources: 1. South Africa Demographic and Health Survey 2016 MCSP South Africa End of Project Report vii Executive Summary From 2015 to 2019, the Maternal and Child Survival Program (MCSP) worked with the Nelson Mandela Children’s Hospital to develop clinical leadership and management skills of nurses with the goal of providing state-of-the-art, specialized pediatric care to children in South Africa and the Southern Africa region. Prior to the opening of the hospital in 2017, MCSP and its partner, Johns Hopkins Medicine International, assisted the Nelson Mandela Children’s Hospital Trust to outline recruitment, management, and onboarding plans for the nursing team. During the phased opening of the hospital, MCSP provided technical assistance to develop nursing policies and guidelines, assisted with readiness checks, and provided targeted hands-on training and mentoring for each unit prior to opening. MCSP also facilitated exchanges for newly hired nurse leaders to work with their pediatric nursing counterparts in the US at the Johns Hopkins hospitals, and provided remote learning opportunities where feasible. MCSP’s technical assistance focused on clinical skills for radiology, dialysis, pediatric/neonatal intensive care unit (PICU/NICU), cardiology, and surgical theaters, as well as the outpatient and day wards. A specific focus was placed on assisting the hospital to develop systems and practices around quality improvement, interdisciplinary teams, and ongoing learning, i.e., via simulations. The project culminated in a three-day pediatric nursing conference, the first such event hosted by NMCH and geared at building the role of the hospital’s nursing team within a network of pediatric specialty nurses in South Africa and the Southern Africa region. With the support of MCSP, NMCH was able to develop a vision for nursing excellence for this one- of-a-kind hospital, informed by international best practices, and to lay the groundwork for a nursing program defined by the highest standards of quality and patient safety. viii MCSP South Africa End of Project Report Introduction In 2014, construction on the Nelson Mandela Children’s Hospital (NMCH) began in