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Table 6 All Babies Count Change Package

From: Successful implementation of a combined learning collaborative and mentoring intervention to improve neonatal quality of care in rural Rwanda

Quality Indicator Targeted Care Gap Change Concept Related Qualitative theme from focus groups Facilities successfully implementing
QI PROJECT: IMPROVING ANTENATAL CARE SERVICES (# Facilities attempting n = 23)
 4 Antenatal care visits Low 4 ANC visit completion because women miss 1st ANC appointment Test women for pregnancy in all departments and transfer for ANC enrollment or same day ANC care if pregnant. Integration of services
Teamwork & Communic-ation
7
Low community awareness of importance of ANC visits Increase community awareness of ANC importance by educating women in waiting rooms of the health facility Teamwork & Communic-ation 2
Engage health center leadership to provide ANC care and demonstrate importance of ANC to the community. Importance of Leadership 1
Engage community leadership to help CHWs emphasize the importance of antenatal care in monthly community meetings Importance of Leadership 1
Health Centers too far for women to reach Decentralize ANC services to Health Posts on a regular basis   4
No mechanism to follow up women who miss appointments Make (a) a filing system of medical records or (b) a register modification to facilitate identification of women who miss appointments for outreach by CHWs Teamwork & Communica-tion 3
No mechanism to remind women of up-coming appointments Have CHWs remind women who have upcoming appointments. Teamwork & Communica-tion 1
Women cannot attend ANC clinic on the day offered Offer ANC care at the health center more frequently (ranges from 2 times per week to daily) and at times that coordinate with community activities (such as market day)   4
Women don’t come for ANC because partner is not available. See women for 1st ANC and send her with invitation for her partner to attend following visit Mentorship &Training 2
QI PROJECT: IMPROVING DELIVERY CARE SERVICES (# Facilities attempting n = 17)
 Time to C-section (District Hospitals only) Poor communication and coordination between maternity and neonatal services Set aside a regularly scheduled time for collaboration between neonatal and maternity services Teamwork & Communication 2
 Appropriate administration of steroids & antibiotics for preterm labor management Low case identification of women in active preterm labor Define scope of problem at health center by comparing preterm infants recorded versus women in preterm labor identified Data utilization 5
Refresher trainings for staff on calculation of gestational age and management of PPROM in order to improve recognition of labor complications & management Mentorship & Training 4
Medical Staff forget that steroids and/or antibiotics may be indicated in preterm birth Modify existing maternity registers to prompt appropriate management Integration of services
Teamwork & Communication
2
Antibiotics not given because not available Have nurses proactively checking on supply of steroids available. Essential equipment 1
Facility-based delivery Women not deliver at the facility because inadequate anticipatory planning Assist mothers with anticipatory planning of items to have prepared to bring for delivery at their 3rd ANC appointment Teamwork & Communication 1
QI PROJECT: IMPROVING POSTNATAL CARE SERVICES (# Facilities attempting n = 12)
 Checking infants for Danger Signs within 24 hours Low maternal knowledge & nurse vigilance in checking for neonatal danger signs Make checking for danger signs part of the maternity register and assign the filling of the register as a daily nursing responsibly to prompt staff to educate the mother and check the newborn for Danger Signs Integration of services 5
Short hospital stays (often same day discharge) preclude staff from checking danger signs When women come to get child’s BCG vaccination makes sure they are also screened for neonatal danger signs Integration of services 1