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REPBLICA DE MOAMBIQUEMINISTRIO DA SADE
Facility based newborn care:Country successes and challenges
Mozambique
Dra. Bernardina GonalvesPediatrician
GLOBAL NEWBORN HEALTH CONFERENCEApril 15-18, 2013Johannesburg, SA
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National Health Servicesat glance
1387 Health Facilities 7 Provincial Hospitals and 3 Central Hospitals 1292 Health Facilities with Maternities- 24
hours/day 1033 provide ANC/PMTCT/FP/PNC- 8 hours/day Density of midwives, nurses and doctors per
1,000 population: 0.3 Health Facilities/habitants: 1/10.000 hab
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Type of HF
Frequency #deliveries
Intra hospitalNM Rate
/1000 Livebirths
CentralHospitals
1.261 21.983 57.4
ProvincialHospitals
639 23.617 27
GeneralHospitals
20 23.219 0.86
RuralHospitals
350 47.668 7.34
HealthCenters
214 195.664 1.09
Total 2.484 312.151 7.96
The main causesof Death werePrematurity
(50%),Severe asphyxia
(32%),
Neonatal sepsis( 29%)
Mortality & Causes of Deaths
Source: Maternal & newborn health needs assessment,2009
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Causes of Newborn Deaths
Source: National Survey : Causes of Mortality, INE 2007
Neonatal Sepsisconstitute the main causeof death amongNewborns born in RuralHealth Centres (27.3%)
and at community level(44.9%)
This demonstrated aneed to improve ouractions and interventionsat these levels to betteraddress the NB sepsismore efficiently
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Intervention Packages Type of HF Type of ServiceProvider
M a t e r n a l
Focused 4-visit antenatal package (tetanusimmunization, detection & management of syphilis, other infections, pre-eclampsia,Malaria intermittent presumptive therapy,folic acid, PMTCT, Counseling and healtheducation)
District, Provincial, GeneralRural Hospitals and Urban,Rural Health Centers ,andOutreach services
MCH nurses, Preventivemedicine agents andtechnicians forvaccination
Doctors (High risk ANC)
Emergency obstetric care /ENCAntibiotics for preterm rupture of membranes
1/500.000 hab (Emoc Basic;5/500.000 hab (Emoc Complete)
MCH nurses, surgicaltechnicians, Doctors
Corticosteroids for PT Central, Provincial, Generaland Rural Hospitals(specialized)
Gynecology& Obstetricspecialists
Family Planning Central, Provincial, GeneralRural Hospitals and Urban,Rural Health Centers andOutreach services
MCH nurses, curativemedicine agents&technicians, Doctors
Model Maternity /Quality performance based standards (2009 & 2011)
Central, District, Provincial,General Rural Hospitals andUrban Health Centers, HealthCenters with maternities
MCH nurses,technicians,Doctors, surgicaltechnicians
Newborn Health Interventions
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Intervention Packages Type of HF Type of Service Provider
N e w
b o r n
Essential Newborn Care / Neonatal Resuscitation(ventilation & cardiac massage)/Management of moderated and Severe Newborn Illness
Central, District, Provincial,General Rural Hospitals
MCH Nurses, pediatric nurses,Generalists, Gynecology& Obstetricspecialists
Essential Newborn Care/ and Helping Babies Breathe(2011)
Urban and Rural Health Centers Elementary/basic midwives, MCHNurses
Integrated Management of Childhood Illness -Neonatal component (2008)- including treatment for
infections with ATB & PMTCT
District, Provincial, General RuralHospitals and Urban, Rural
Health Centers and Health Posts *
MCH Nurses, pediatric nurses,Curative Medicine Agents &
Technicians , Generalists
Kangaroo Mother Care (2009) Central, District, Provincial,General Rural Hospitals andUrban, Rural Health Centers
MCH Nurses, pediatric nurses,Curative Medicine Agents &Technicians , Generalists, specializedDoctors
Post-natal care with focus on the 1st week of life (visiton day 3, 7) and between day 21-28 to support
health practices and earlier detection and referral of complications
District, Provincial, General RuralHospitals and Urban, Rural
Health Centers and outreachservices
MCH Nurses, pediatric Nurses,
Model Maternity (2009) Neonatal component(immediate skin-skin contact, early breastfeeding early - first hour after birth , neonatal resuscitation and PosNatal Care - 3, 7 and 21-28 days after deliver)
Central, District, Provincial, GeneralRural Hospitals and Urban HealthCenters, Health Centers type I and A
MCH Nurses, pediatric Nurses,Generalists, Gynecology& Obstetricspecialists, Curative Medicine Agents &Technicians , Generalists, Managers
Quality performance base standards (2011)
Newborn Health Interventions
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COVERAGE OF SPECIFIC INTERVENTIONS
Number of health facilitieswith Emergency Obstetric
&Newborn Care:
530 out of 1.292 HF
More than 1.000 healthworkers have been trained
in ENC from 2009 to2010
IMNCI :Since 1998 the package
has been scaled up to 144Districts with support from
country collaborationpartners.
In 2008 the strategy wasupdated to add Neonatal
Care and HIV/AIDS.
Implementation of anaction plan for effectiveroll out
will start in May 2013
KMC:The method have been
introduced to all Provinces.In most HF it is an integrated
service( no specific units)
KMC is integrated as keythematic issue in most
continuing education MNCHtrainings.
HBB : Recently adopted by theCountry.
330 Health Workers and 43National master trainers havebeen trained , an action plan to
accelerated the roll out of HBB iscurrently being prepared .
The coverage of the interventions within the provinces is variable depending onlocal partners support..The country still need to improve M&E system to monitorimplementation of these interventions as well as certification of the HF thatimplement it. Preliminary data from national quality assessment of newbornservices done in 2012 is still to be finalized.
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P e r c e n
t a g
e
Quality Standards Areas
Data from 28 Health Facilities
uccesses:Improving Quality with Performance
based Standards
Inclusion of NB Quality Standards indicators in the HIS
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Data from 28 Health Facilities
Comparison between the Baseline (2009-10) and theLast Measurement (Q4 2011 or later)
Inclusion of NB Quality Standards indicators in the HIS
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Training of health professionals in the area of Maternal & newbornhealth, targeting all District Staff(not only specific HF staff toovercome the issue of high turn over)
Inclusion of the package interventions in pre service trainingcurriculum ( HBB in discussion for inclusion)
Inclusion of materials & equipment as an essential item in existingmaterial & equipment Kits(Penguin, Bag & Mask, essential drugsfor NB resuscitation, ATB( IM/IV) for Sepsis/infections, EmOC kits)
Emerging Maternal and Newborn audit committees based on clearoperational guidelines Community Health Communities & Co-management Committees
operational Guidelines to promote effective Community-HF
linkages
Successes :Working towards Sustainability
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Challenges
Insufficient availability of human resources/Weak institutionalcapacity for retention of qualified human resources
Implementation of an action plan to accelerate roll out of IMNCI,HBB and KMC( training and mentoring of HW, supplies,certification criteria and Inclusion of specific indicators for thoseinterventions at HIS/routine data management )
Improve the health infrastructure to the newborn (to reduce
overcrowding services neonatology to prevent sepsis)
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Improve the availability of ATB (parenteral) to treatsepsis and other commodities/material andequipment at all levels
Upgrading of existing Health Post
Update IMNCI training curricula for
Revision of training curricula, role & responsibilities of
TBAs, APEs and other Community Health Volunteers
Challenges
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