Table 2 Improvement topics
Tanzania | Uganda | |||||
|---|---|---|---|---|---|---|
Facility | Community | District | Facility | Community | District | |
Primary outcomes | ||||||
Facility delivery Indicator: women reporting having delivered their last baby in a facility | -Promotion of birth preparedness at ANC -Tracking of home birth together with community volunteers -Male involvement/encourage men to come for ANC for joint counselling (November 2011/February 2012–April 2014*) | -Encouragement of facility delivery through home visits and community meetings -Engagement with traditional birth attendants -Escort women to facility in labour -Community fines to family who delivered at home (November 2011/February 2012–April 2014) | -Health managers emphasised importance of health facility delivery during contacts with facility staff | -Encouragement of facility delivery and birth preparedness during ANC counselling (November 2011/January 2013–April 2014) | -Community sensitisation on the importance of birth preparedness and facility delivery during village meetings and religious gatherings -Birth preparedness checklist for each pregnant woman used during home visits -Home visits to ensure items are bought (at least 3 visits) Male involvement—sensitization to bring men to ANC -Follow up pregnant mother using EDD -Referral of pregnant mother in labour to nearby facility with referral note (November 2011/February 13–April 2014) | -Facility delivery improvement discussed during the quarterly district meetings (November 2011–April 2014) |
Immediate Breastfeeding Indicator: women reporting breastfeeding within 1 h | No action | No action | No action | -Mother and baby kept together after delivery -Mother shown how to attach and breastfeed by health worker (January 2013–April 2014) | No action | No action |
Uterotonic within 1 min after birth Indicator: population indicator “effective coverage” of uterotonics within 1 min after birth | -Orientation of staff Pre-loading of syringe -Improved ordering (November 2011/February 2012–April 2014) | No action | -Support to improved ordering of oxytocin Revision of ordering document and flow -Purchase of oxytocin using district resources (basket funds) (February 2012–April 2014) | -Orientation (on-job training) of health workers on AMSTL -Continuous education sessions on AMSTL Creation of a column in the delivery register for recording AMSTL -Preparation and ensuring that oxytocin is kept/replaced in labour suite each morning -Health Centre IIs request for oxytocin from Health centre IVs (January 2012/January 2013–Apr 2014) | No action | -Ensure adequate supplies of oxytocin in Health Centres III, IV and in a hospital -Permission for Health Centre IIs to request for oxytocin from Health Centre IIIs and IVs -Work with Health Centre IIIs and IVs to include oxytocin forecasts for health centre IIs in their requisition (January 2012–April 2014) |
Knowledge of pregnancy danger signs Indicator: mothers reports of knowledge | Danger signs counselling during ANC (February 2013–April 2014) | -Home visits by volunteers (February 2013–April 2014) | District managers mentored and supported health staff (February 2013–April 2014) | Counselling on danger signs during ANC (February 2012/February 13–April 2014) | Counselling on danger signs during home visits (February 2012/July 13–April 2014) | No change idea Community knowledge on danger signs presented on a quarterly basis to district team through report cards |
Knowledge of newborn danger signs Indicator: mothers reports of knowledge | Home visits by volunteers (July 2012–April 2014) | District managers mentored and supported health staff (July 2012–April 2014) | Counselling on danger signs during ANC (February 2012/February 2013–April 2014) | Counselling on danger signs during home visits (February 2012/February 2013–April 2014) | No change idea Community knowledge on danger signs presented on a quarterly basis to a district team through report cards | |
Other/improvement topics chosen by teams | ||||||
Post-partum care indicator: mothers’ reports on timing of post-partum care | Keeping women 48 h post-partum in facilities -Counselling of importance of PNC during ANC (November 2011/February 2012–April 2014) | -Home-based counselling on importance of early post-partum care and getting births and birth certificates -Counselling of men to prepare for PNC (November 2011/February 2012–April 2014) | District managers mentored and supported health staff (February 2012–April 2014) | -Give mothers appointment dates for PNC before discharge -Immunise baby but retain Child Health Card till mother comes back for PNC -Health education of mothers on importance of PNC -Re-design clinic so that PNC is held on separate days from ANC -Young child clinic days -Work with VHTs to remind mothers to go for PNC at health facility (November 2011/January 2013–April 2014) | Follow up of all pregnant women (home to home visits) for PNC Community sensitisation on PNC in places of worship Use village leaders to enforce PNC attendance (November 2011/July 2013–April 2014) | No change idea PNC coverage reported on a quarterly basis to district team through report cards |
Clean birth kits Indicator: women report having prepared clear birth kits in home deliveries | Educating women of what to purchase for a safe delivery during ANC | Home-based counselling on birth preparedness (April 2012–April 2014) | Support and mentoring | Merged with birth preparedness counselling during ANC | Counselling on birth preparedness during home visits (April 2012/January 2013–April 2014) | |
Helping babies breathe, drying and wrapping of babies Indicator: mothers report immediate wrapping of babies during last birth | Helping Babies Breathe training (March 2013–April 2014) | No action | Support and mentoring | No action | No action | No action |
ANC 4+ Indicator: mothers report four ANC visits | No action | No action | No action | Sensitisation on importance of four ANC visits Work together with CHWs to promote 4 ANC visits (November 2011/January 2013–April 2014) | Community sensitization through village meetings, religious gatherings Sensitise men to support their spouses to go for ANC (male involvement) Sensitise women on importance of ANC during home visits CHWs refer mother to HF for ANC (with referral note) (November 2011/July 2013–April 2014) | No action |
BCG immunisation Indicator: mothers reports of | No action | No action | No action | On-job training and CME for staff on vaccination Do not discharge mother till baby is vaccinated (April 2012/January 2013–April 2014) | Follow up all deliveries in the community to ensure that babies are immunised Home visits to verify immunisation through child cards Community sensitisation meetings on importance of immunisation (April 2012/February 2013–April 2014) | -Support for projection, requisition and procurement of vaccines -Repair all spoilt fridges in health facilities -Ensure that all facilities have gas for the fridges (April 2012/February 2013–April 2014) |
Infection prevention Indicator: infection prevention items included clean running water, disinfectant, soap and gloves available in delivery room | Re-organisation of labour room, ordering of supplies using locally available funds (July 2013–April 2014) Reorientation of staff on prophylactic antibiotics for Caesarean section in the district hospital (Nov 2011–April 2014) | Recognition of danger signs for infection together with danger signs post-partum (July/August 2013–April 2014) | Support to mobilising local funds for purchasing supplies for infection prevention (July 2013–April 2014) | No action | No action | No action |
Supervision Indicator: documentation of supervision visit from district managers in past 6 months | No action | No action | -Improved roster management -Earmarking of district funds for fuel -Supported facility staff to improve documentation of supervision visits including dates visited, purpose and cadres of the supervisors (November 2013–April 2014) | No action | Community QI teams to be supervised by Health Assistants on a monthly basis (November 2011/February 2013–April 2014) | District QIT to support facility QITs on monthly basis during mentoring and on quarterly basis during learning sessions (November 2011–April 2014) |
Other improvement topics | ||||||
Syphilis testing | Improved ordering of testing materials (Nov 2011–March 2012 in pilot division) | |||||
Timely and correct use of partographs | -On-job training of staff on partograph use -Copying of partograph forms (August 2013–April 2014) | No action | No action | -On-job training of staff on partograph use -Request for partographs from District Health office -Reminder on labour ward wall on use of partograph -Photocopy partographs for use Keep partographs in labour suite for easy access (November 2011/January 2013–April 2014) | No action | Support requisition and procurement of partographs Photocopy partographs to be supplied to facilities (November 2011–April 2014) |