Dr Margaret Nakakeeto is the chairperson of the Newborn Steering Committee of the Maternal Child Health Technical Working Group of Uganda’s Health ministry. In this interview with Kakaire Ayub Kirunda, she shares the committee’s achievements over the last one year and prospects for the future.
Newborn care is in the limelight lately, why are we still losing babies across the country?
There is a lot we could have done in the past which can still be done. I believe we can still shine and had always wanted to contribute especially towards policy and guidelines but never had no opportunity. So, when I was nominated last year to head the Newborn Steering Committee it was an opening to realise my dream guided by my skills and passion for newborn health.
In this country, there has been a lot of focus on clinical work forgetting the human resource component. As you move around, you find that apart from being inadequate in numbers, many health workers are unskilled and unmotivated as far as newborn care is concerned. And the staff welfare especially at lower level facilities is wanting and a very big demotivation factor.
However, guided by the Reproductive, Maternal, Newborn, Child and Adolescent Sharpened Plan for Uganda, I pitched my idea of the Uganda newborn care chapter 2019, which calls for a responsive and sustainable system. I don’t want us to continue lamenting anymore.
So, how far have you gone as far as putting to test the Uganda newborn care chapter 2019 is concerned?
I started by convincing the Newborn Steering Committee together with some implementing partners and few technical people at the ministry to take a learning visit to Kiwoko Hospital, which has a fully-fledged Neonatal Intensive Care Unit, yet in a rural setting north of Kampala. While there we toured the different units. I wanted them to see and believe that we can indeed improve newborn care in this country. Electricity, water and infrastructure are very critical in the care of newborns and are all catered for at Kiwoko. There is no way you can run machines without electricity, cleanliness and infection control cannot be maintained without water and there must be some set up designated as a treatment area for babies. And trust me after that visit I even saw the engineers adjusting their Health Centre III plans they had made, to make room for newborn care. They added provision for 4 kangaroo mother care (KMC) beds, next to the KMC area there is provision for a stabilisation corner, so babies are not just sent away.
In our new thinking there should be no referral at night especially from district hospitals. Because at night the whole structure, even at national level, administration is closed and even if you needed fuel you may not be able to access it. So, let the baby be stabilised first. For instance, if you gave gentamicin the next dose would be in 24 hours, so there is no hurry. Once the baby is warm, a feeding tube is passed (if needed), baby is on oxygen, why the hurry? There is no hurry unless an unborn baby in a mother’s womb is at risk.
Is that all we can talk about in the last one year?
My plan of changing mindsets did not end at only the ministry team but had to start from there. An opportunity came with the USAID RHITES-North Project which expressed interest in improving newborn care in the Acholi sub-region. We entered into partnership. Again, I started off with arranging a visit to Kiwoko for the leadership from the sub-region including hospital heads and administrators, district health officers and chief administrative officers and principal nursing officers among others. With this exposure, if a health worker walked into any of these officials, they would easily understand what they are talking about. After administrators the clinical people also were taken to Kiwoko.
When they returned, they made workplans and most of their workplans were mainly for infrastructural changes and re-organisation of the staff. Before even the clinical teams went to Kiwoko the managers had already started changing the infrastructure and trying to look for things here and there. In one place a water pump that had not worked for 8 months was fixed.
There was a quick turn of events at Gulu Regional Referral Hospital where there is now a functional Newborn Care Unit. The visit to Kiwoko was mind changing. Upon return they realised they had most of the things needed to make a start. They were idle in the stores. Now from the cleaners to the administrators everyone is interested in the functionality of the NCU. The same spirit is now being manifested in Kitgum, Anaka and Kalongo hospitals. At Kalongo we have a director who is a surgeon but also interested in newborn care. Soon after her surgical ward round she used to rush for mentorship in newborn care and has also seen the importance of separating the NCU from maternity.
We did three months of consecutive mentorship and now services are running smoothly. For sustainability of the mentorship, we started a WhatsApp group and have helped with the treatment of so many babies via online consultation.
After Acholi sub region, Busia District in the East has come on board with support from World Vision and our next stop is Kamuli and Buyende districts in Busoga sub region where in partnership with implementing partners led by Plan International, we hope to replicate the Acholi experience. And after that six districts in Central will come on board with support from the Clinton Health Access Initiative.
You seem to be working largely with non-government entities, how will the things you are doing be sustained? We have made it clear to our partners that they are working under the Ministry of Health. Before, each partner was doing their own thing. They had compartmentalized the whole country. So now whatever is being done is following the Sharpened Plan and we are all doing the same thing. We are embedding everything in the existing system as opposed to vertical programming. And we are succeeding because until recently we never used to have all these partners on the same table talking the same language.
Attitude of health workers is often blamed for poor services, wont this affect the renewed energy in newborn care? Their managers should be there for them. Let health workers be given what they need to use and be treated like family. Trust me their morale will be boosted. The family centred concept of care should also include health workers. Leaders should be team players as well. Managers should show concern regarding welfare issues pertaining to their workers.
Do academic institutions have a role to play in the newborn care agenda? These institutions have a big role in mentorship and training. So, we are going to have the academic institutions involved and that is one of the sustainability plans because these will never go away. Fortunately, every regional referral hospital catchment area has a training institution within the vicinity. These are additional human resources that need to be tapped. We have also been made to understand that biomedical engineering students will help in working on equipment regularly. ###
*This interview was first published in the newly launched annual “Newborn Health Magazine”