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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