CMNH Annual Review
The recently released Centre for Maternal and Newborn Health Annual Review 2015 highlights the work of the Centre over the last year as it continues to introduce and scale-up interventions known to be effective in improving maternal and newborn health outcomes.
You can download a copy of the report from here
'Improving the Quality of Care Using Audit'.
In October 2015, Professor Nynke van den Broek and Dr Charles Ameh, in collaboration with HEART (Health and Education Advice & Resource Team), participated in a seminar on "Quality of Maternal and Newborn (MNH) services- an online learning resource for DfID Health Advisors".
A video is available to watch on the 'Improving the Quality of Care Using Audit'.
Professor van den Broek talks about the approaches to doing audits in relation to Maternal and Newborn Health in development settings. Dr Charles Ameh, Deputy Head of CMNH, also provides a case study on the relevance of using confidential inquiry into maternal deaths in Kenya.
Making it Happen dissemination meeting in Sierra Leone
CMNH, in partnership with the Ministry of Health and Sanitation and UNICEF, disseminated the results of the Making it Happen (MiH) programme on 7th April 2016 at Hill Valley Hotel, Freetown.
The event was Chaired by Dr Conteh, Programme Manager Reproductive Health and Family Planning, and the Honourable Abdula D. Sesay, Chair of the Parliamentary Health Services Commission, was in attendance. Dr Sarian Kamara (Deputy Medical Officer 1) gave the keynote speech, praising CMNH and partners for the positive impact of the MiH programme on maternal and newborn health in Sierra Leone. The meeting was well attended by members of UNICEF, WHO, MoHS and other INGO working in Sierra Leone.
The MiH programme started in Sierra Leone in 2009 with the aim of reducing maternal and newborn mortality through capacity building of health care workers. Despite challenges in delivering the programme during the Ebola epidemic, results from facilities followed up for monitoring and evaluation show that MiH has contributed to a 46% increase in the availability of specialist obstetric care at facilities providing basic emergency obstetric services, and a 22% reduction in the still birth rate at facilities providing comprehensive emergency obstetric care followed up for M&E.
The meeting ended with Dr Sarian commending the CMNH for the impact of MiH and for working in partnership with MoHS and the Reproductive and Child Health Directorate before she declared the closure of the MiH programme in Sierra Leone.
Susan Jones (Senior Research Associate), Betty Sam (Senior Technical Officer, Sierra Leone) and Florence Bull (technical Officer, Sierra Leone) represented LSTM at the event.
Making it Happen dissemination meeting in Tanzania
CMNH, in collaboration with the Ministry of Health, Gender, Elderly and Children, disseminated the results and lessons learnt from the DFID-funded Making it Happen (MiH) programme on the 18th of April 2016 at the Courtyard Protea Hotel, Dar es Salaam. The meeting was chaired by Dr Neema Rusibamayila, Director for Preventive Services at the MoHGEC, and Dr Georgina Msemo, Head of Division of Reproductive and Child health services.
The MiH programme was implemented from January 2012 to December 2015 in Pwani and Kagera Regions. A country- adapted competency-based training programme in Emergency Obstetric and Newborn Care for both pre-service and in-service health care providers; provision of essential EmONC equipment, and monitoring and evaluation were the key CMNH interventions implemented. Also, Tanzania was one of the six countries included in the twelve months follow-up on knowledge and skills retention study, a longitudinal cohort student embedded under the MiH programme.
The meeting was well attended by members of the UN family (UNICEF, UNFPA), donor community (DFID, USAID, Irish Aid, SDC and GIZ), other implementing partners (JHEPGO, Save the Children, White ribbon alliance) and professional medical and nursing/midwifery associations (TAMA, AGOTA).
In her remarks, Dr Rushibamayila said “we are happy to have a country-adapted programme as agreed with Liverpool at the design phase of the programme”. She further added that “we are able to own the good results and lessons learnt from this programme that has contributed to the 50% reduction in maternal mortality ratio ratio recorded in the country”. She encouraged the donor community to invest more so that these interventions can be scaled up so that preventable maternal mortality can be eliminated and Tanzania can meet the Sustainable Development Goal target for maternal health. Dr Msemo said she would like the training to be adapted by the country with great emphasis on pre-services training. Dr Sudha Sharma, who is the county lead for UNICEF Tanzania, also encouraged donors to invest in scaling up this programme for Tanzania.
The aim of this 2.5 day workshop was to work together to ensure workshops are delivered in a standardised way across all countries and to the highest standard, making sure that the learning is applicable and takes account of the real-life challenges health-care providers and managers who support maternity care face on a daily basis. It is expected the outcome will improve capacity, and a critical enthusiastic well-informed group of facilitators will deliver this intensive four module workshop to healthcare providers countrywide.
The first day was led by CMNH staff providing updates on learning resources and troubleshooting key challenges in delivering workshops on quality improvement. Dr Florence Mgawadere updated participants on the new ICD-MM classification system for maternal deaths; Dr Mamuda Aminu took participants step-by-step through the process of perinatal death audit, and Dr Helen Smith led discussions on how best to support the implementation of standards-based audit to improve quality of care in facilities.
CMNH staff also introduced the new facilitator guide to accompany the training manual currently being used in Kenya and other CMNH partner countries. The facilitator guide, with its emphasis on participatory learning, will help the Kenya team to deliver the workshops more effectively. Fresh off the press, the innovative CMNH training manual (one of a series produced by CMNH) on Improving Quality of Care for Mothers and Babies will help support health care providers and managers to transform quality of care in Kenya.
Another highlight for participants was seeing for the first time the much anticipated National Guidelines for Maternal and Perinatal Death Surveillance and Response produced by the Ministry of Health Kenya with contributions from CMNH. The Head of the LSTM Kenya office, Judith Maua, made this comment on the quality improvement workshops: “The workshops have gone very well, it’s very exciting! QI is coming up in a big way in Kenya and is taking the same direction as emergency obstetric care training. QI is a new area, so consistency in training and scale up via a critical mass of trainers is important. I’m very excited we now have a real facilitator package for QI, based on audit methodology, which can help increase our confidence in delivery of workshops and scale up. We want Maternal and Perinatal Death Surveillance and Response (MPDSR) and QI to reach the same level as EmOC in Kenya.”
The Head of CMNH, Professor Nynke van den Broek, commented that CMNH’s quality improvement work is centred on “facilitating participatory workshops to discuss real life problems and solutions in quality of maternity care”. CMNH staff then worked with the LSTM Kenya team to deliver a high-quality national one day workshop training 40 participants (obstetricians, reproductive health co-ordinators, nurse-midwives and senior managers) from all counties in Kenya.
Quality improvement is the most recent component of a larger programme of CMNH work in Kenya funded by DFID and UNFPA. Other components include improving the availability of maternal and newborn care via competency-based training in Emergency Obstetric Care, and establishing a national MPDSR system via a LSTM supported Secretariat within the Ministry of Health. Implementing the three components together will increase maternal and newborn health outcomes in Kenya.
CMNH, together with UNICEF and WHO, has organized a two day workshop on quality of care (QoC) for mothers and babies in Lilongwe, Malawi.
The meeting was opened by the Malawi Minister of Health Dr. Peter Kumpalume; Juliana Lunguzi, a Member of the Malawian Parliament; and by the representative of UNICEF, Mahimbo Mdoe, in presence of more than 65 participants from District Health Offices, local training institutions, MoH officials and the donor community. Senior experts from UNICEF New York and from UNICEF Regional Office also attended the meeting which, following the opening remarks, included keynote presentations by the Head of CMNH, Professor Nynke van den Broek, and her colleague Dr Helen Smith.
Gathering evidence produced through an ongoing partnership between UNICEF, WHO, the Ministry of Health and CMNH, the workshop focused on aligning stakeholders on global quality of care policies, strategies, frameworks and standards. In addition, participants presented and validated the findings of a QoC assessment performed in Malawi; shared evidence, lessons learned and best practices on QoC; and identified priorities for research in quality of care in Malawi.
Professor van den Broek said: ‘The workshop was a great success. I am very proud of the work done by CMNH and partners here, to enhance quality of care for mothers and babies and to discuss the evidence we generated for what works well, what not and why. Overall, CMNH and partners have really done fantastic work to have a better understanding of the research needs and priorities so that to the Quality of Care interventions in Malawi can be scaled up successfully.’
In his closing remarks, the Malawian Minister of Health referred to Professor van den Broek's presentation and highlighted her experience on improving quality of care in Malawi, and he concluded recommending that the Ministry of Health adopts a dashboard to map Quality of Care along the lines of the one designed by LSTM in partnership with WHO and UNICEF.
We are delighted to announce that CMNH has been successful in becoming a preferred supplier for UNICEF in the Eastern and Southern Africa Region (ESAR). CMNH was shortlisted from a group of 600 applicants and will provide expertise for research and/or technical assistance in health to UNICEF ESAR as needed.
UNICEF often counts on institutional experts to provide appropriate technical support and has identified five regional programmatic priorities for the period 2014-2017:
1. Enabling children to survive and thrive.
2. Reducing stunting to provide opportunities for children to realize their full potential.
3. Improving education quality and learning outcomes to prepare children for the future.
4. Achieving results for adolescents (R4A) that help them manage risks and realize their full potential.
5. Scaling up social protection interventions to reduce child poverty and other vulnerabilities that impede the full realization of child rights.
CMNH is likely to get involved in helping UNICEF ESAR and their country offices in a range of research areas.
CMNH is conducting a survey about the benefits of healthcare volunteers facilitating our training course - the 3-day ‘skills and drills’ training package in Emergency Obstetric Care and early Newborn Care.
The study is entitled: Healthcare volunteers who facilitate training in maternal and newborn health programmes in low and middle income countries: an online survey regarding the benefits for the volunteer, the host country and sending country.
Since 2006, the UK volunteers working with CMNH, have delivered training in eight African and three Asian countries, and 1681 national facilitators trained, and we are keen to explore the benefits of this programme.
We are very interested to hear about your views, opinions and experiences. You will be contacted within the next two weeks via email to kindly ask for your participation.
CMNH is pleased to announce several papers are now published and available online describing some of the work we have led or been involved with. These include analysis of why women die as a result of pregnancy and childbirth in Malawi, what needs to be done to support healthcare providers to recognise and manage such complications, and finally we highlight the importance of ensuring a continuum of care for women wherever they are. Happy reading!
Dr Florence Mwagadere conducted the first ever Reproductive Age Mortality Study (RAMOS) in Malawi and as part of this compared cause of death as assigned by a facility-based maternal death review teams, an expert panel using the new ICD-10 cause classification for deaths during pregnancy, childbirth and the puerperium (ICD-MM), and a computer-based probabilistic programme (InterVA-4). This shows that at district level capacity needs to be built to ensure health care providers understand and are able to use ICD-MM. CMNH includes this in our Quality Improvement workshops including in 5 districts in Malawi.
The results of the study were published in the British Journal of Obstetrics and Gynaecology (BJOG) and are available through the following link: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.13969/epdf
Professor van den Broek is one of the lead members of the WHO Maternal Morbidity Working Group. Recently this group published an article which provides the first standard definition and classification of Maternal Morbidity. CMNH has applied this definition and criteria to conduct a study in 4 countries including >10,000 women assessed during and after pregnancy – more papers from CMNH on this important topic are under review. The first article in BMC Pregnancy and Childbirth has been accessed more than 600 times in the first month of publication and is ranked in the top 25% of all research outputs scored by Altmetric.
Chou D, Tunçalp Ö, Firoz T, Barreix M, Filippi V, von Dadelszen P, van den Broek et al. (2016) Constructing maternal morbidity – towards a standard tool to measure and monitor maternal health beyond mortality. BMC Pregnancy & Childbirth, vol. 16, no. 1, p. 45. doi: 10.1186/s12884-015-0789-4 Available at: http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0789-4
Susan Jones, one of the Senior Research Associates in CMNH has been working with UNICEF to conduct an analysis of the Maternal and Child Health Aide training programme in Sierra Leone including all 14 MCHAide schools across the country described in the paper below. This has been followed with a very successful programme to support tutors of all schools across Sierra Leone – expect additional publications highlighting this important work next quarter!
Jones SA, Sam B, Bull F, James M, Ameh CA, van den Broek NR. (2016) Strengthening pre-service training for skilled birth attendance — An evaluation of the maternal and child health aide training programme in Sierra Leone. Nurse Education Today, vol. 41, no. 2016, pp. 24-9. doi: 10.1016/j.nedt.2016.03.018 0260-6917 Available at: http://www.nurseeducationtoday.com/article/S0260-6917(16)00124-6/pdf
In the coming years CMNH will be expanding its work to look at availability and quality of antenatal and postnatal care for women in low- and middle-income settings. We have been invited to write two commentaries for BJOG:
van den Broek N (2016) 'Content and quality – integrated, holistic, one-stop antenatal care is needed for all', BJOG, vol. 123, no. 4, pp. 558. doi: 10.1111/1471-0528.13937 Available at: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.13937/full
A second commentary written by Dr Mary McCauley and Professor van den Broek, Eliminating congenital syphilis – Lessons learnt in the United Kingdom should inform global strategy, will be published next quarter.
To highlight the importance of documenting and tracking how financial aid is disbursed and used please read commentary below:
van den Broek N. (2016) Official Development Assistance for reproductive health has increased but may not be going to those who need it the most. BJOG, epub ahead of print. doi: 10.1111/1471-0528.13908 Available at: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.13908/abstract
Eighteen students completed their Diploma in Sexual Reproductive Health in Developing Countries (DSRH) course at LSTM in April.
The twelve week course is run by CMNH is delivered using a range of teaching methods, including small group work, group discussions and interactive lectures.
This year the course had students from Somalia, Bangladesh, Kenya, Tanzania, Malawi, Sierra Leone, Nigeria, Australia and Japan.
This issue we will focus on one student from Sierra Leone and their experience.
Salome Paul is a Registered Nurse Midwife, a Public Health Officer working in UNICEF Sierra Leone as a Health Officer covering six districts in the South and Eastern Regions of the country.
"My key role is monitoring of all UNICEF Health programmes, supportive supervision and capacity-building of health workers within these regions.
I am a facilitator on Life Saving Skills for LSTM; with the knowledge gained during these twelve weeks on Sexual and Reproductive Health course I have gained an in-depth understanding of the link and effects between sexual and reproductive health and Maternal and Neonatal Mortality which I will take back home and use in capacity building of health workers by conducting On the Job trainings and facilitating trainings/programs for LSTM/UNICEF, thereby helping in reducing the maternal and neonatal mortality in the country. I now appreciate the importance of relevant, correct and timely data."
LSTM played host to The Rt Hon George Osborne MP, and the American philanthropist Bill Gates on the 25th January. Both guests addressed an audience of invited guests and media to talk in detail about the recently announced Ross Fund.
The £3 billion Ross Fund, named after the UK’s first Nobel Laureate and LSTM’s first lecturer, Sir Ronald Ross, will be used to support the global fight against malaria and other infectious diseases. The Fund will be supported by the Bill and Melinda Gates Foundation (BMGF) of which LSTM is a major recipient. LSTM Director, Professor Janet Hemingway CBE, welcomed all guests to LSTM, making reference to LSTM’s past and its current standing at the forefront in the fight against malaria and other tropical diseases.
Professor Janet Hemingway said that ‘LSTM is proud to be chosen as the venue for the more detailed announcement on the Ross Fund, given LSTM’s association with Ronald Ross. It is a unique opportunity that this money is being made available to further the ongoing excellence in research, particularly in the field of resistance to infectious diseases. A huge amount of progress has been made over the past decades but we are increasingly facing new challenges especially in trying to stem the rising tide in insecticide resistance, a rapidly growing problem in vector control.’
CMNH would like to welcome new starters to the team.
- Siv Steffan NyGaard- Research Associate- who joined the team in February.
- Margaret Caffrey joining CMNH from 1 May as Senior Technical Officer.
- Matthews Mathai joining CMNH from 1 June as Professor in Maternal and Newborn Health.
New research projects CMNH has won since 1 January 2016 are listed below.
- Comprehensive External Evaluation of the Community Health Program in Rwanda
- Improving the availability and quality of maternal and newborn care in Kwara State, Nigeria
- Health Workforce Assessment in Timor Leste
- Assessment of Continuous Positive Airway Pressure use in Newborn Care Units to strengthen Newborn Services in India- CPAP2
- Improving Maternal and Newborn Care in Cambodia
- Technical Assistance for the development of a national EmONC improvement plan in Zimbabwe
- National Assessment of Emergency Obstetric and Newborn Care (EmONC) in Namibia
- Center of Excellence in Global Health Policy Development and Governance in China
- Maternal Morbidity India and Pakistan
CMNH will be hosting a Maternal and Newborn Health technical meeting on the 24-26 May in Liverpool with technical specialists from African and Asian countries to disseminate results from Making It Happen programme and discuss CMNH’s wider portfolio of work.
We will also be launching a brand new website at the end of the month. We will send an email announcing when this is live as we would really appreciate your feedback.