Successful quality improvement projects must be integrated but feasible, based on the context and building onto the available resources, and implemented over a fairly long time. Creating a network of regional hospitals via a quality improvement collaborative rapidly leads to improved referral care and increased access to high-quality services for mothers and newborns. Once these efforts are operationalized and functional in hospitals, high-volume primary health centers can be brought aboard, which leads to scale-up.
Having a network of hospitals working to improve quality can be a platform for learning, research, and knowledge generation and for building advanced neonatal care units in places where they hitherto never existed. However, such efforts must be complemented by recruiting more specialized health workers, such as neonatal nurses, pediatricians, and neonatologists, into regional and district hospitals so that nurses and midwives are well supported.
Those are the implications from our four year MANeSCALE (Maternal and Newborn Scale-up) project conducted in the eastern Uganda sub region of Busoga.
This project was designed and implemented in 3 phases in the 6 main hospitals in east-central Uganda from 2013 to 2016. First, the inception phase engaged health system managers to codesign the intervention. Second, the implementation phase involved training health providers, strengthening the data information system, and providing catalytic equipment and medicines to establish newborn care units (NCUs) within the existing infrastructure. Third, the hospital collaborative phase focused on clinical mentorship, maternal and perinatal death reviews (MPDRs), and collaborative learning sessions.
Lessons and details of this study are published here in the Global Health: Science and Practice journal.
See related video: https://youtu.be/6bYWtKk_4lA