Experiences of mothers and newborns in Bangladesh health systems Ishtiaq Mannan Save the Children Sanwarul Bari Abdullah Nurus Salam Khan icddrb Context Achievements Challenges of health systems ID: 504453
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The First Hours of LifeExperiences of mothers and newborns in Bangladesh health systems
Ishtiaq Mannan, Save the ChildrenSanwarul Bari, Abdullah Nurus Salam Khan, icddr,bSlide2
ContextAchievements
Challenges of health systemsPreparednessPracticeHRPhysical
National response
Outline
Capacity
QISlide3
ContextSlide4
16
214232
Place of deliverySlide5
42%
Type of assistance at deliverySlide6
AchievementsSlide7
MDG 4Slide8
MDG 5Slide9
Health Systems Bottlenecks
The Bangladesh paradoxGovernance, stewardship and accountabilityFinancingHR
Quality
Logistics
Measurement
EquitySlide10
METHODSSlide11
Sites and ToolsData from on-site observation of deliveries conducted during the System Evaluation of Scaling up of HBB
Sites:Sub-District hospital (16): 16 UHCTotal 221 SBAs (Doc/Nurses/Paramedics): 7138 deliveries (1776 at baseline)Community component: (6 months of observation)Total: 39 CSBAs (332 deliveries)Tools:Observation of delivery and immediate newborn careKey informant
interview (District hospital and MCWC)Slide12Slide13
KEY Findings:Preparedness and practicesSlide14
Environment of the Delivery Room
Environment delivery roomFacilityN=1161Adequate light in the delivery room62.6 (727)
Adequate ventilation89.7 (1041)
*Multiple responsesSlide15
Availability of ENC Equipment
Essential equipment*FacilityN=1776CommunityTwo pieces of cloths94.4 (1677)
99.4 (330)
Two gloves98.6
(1752)
98.8 (328)
Umbilical clamps/threads
98.5 (1749)
99.4 (330)
Scissor/ blade
98.4 (1747)
100.0 (332)
Suction device
80.6 (1432)
57.2 (190)
Resuscitation bag
66.2 (1176)
53.3 (177)
*Multiple responsesSlide16
Equipment: sterilizationThe nurse working in labor ward of district hospital said about sterilization of
instruments: “We don’t use autoclave machines here. We use savlon water, clean with hexisol, that’s how we manage because we deliver a lot. We also use chlorine solution in OT for disinfection and also boil instruments. But we mainly clean with hexisol” More in the MCWC, the FWV uses the autoclaved instruments for cord clamping and cutting. The medical officer of MCWC described about the sterilizing practice there: “We autoclave the instruments upstairs for OT (where autoclave room is situated). Actually in delivery room instruments are not always autoclaved. Mainly boiled.” A nurse from the district hospital mentioned: “We don’t have dry sheet or clean cloth supply in the hospital, so we depend on what patients bring with them.” Slide17
Overall Preparedness for All
Services is Very Poor
Bangladesh Health Facility Preparedness Survey, 2014Slide18
Preparedness protocolsStandard operating proceduresSpecificationsTable of equipment
Challenges: PreparednessSlide19
Preparing for Delivery and Newborn Care: LogisticsSlide20
Preparing for Delivery and Newborn Care: Physical ExaminationSlide21
Handwashing Practices
HandwashingFacility (N=1776)Community(N=332)Washed hands before delivery 44.1
(783)
46.0 (152)Washed hands with water only
8.0 (140)
2.1 (7)
Soap and others
36.0 (643)
44.0 (145)Slide22
Managing the Delivery of PlacentaSlide23
Did the SBA seek assistance to help resuscitate the newborn?42.8
40.6all newborns
Facility
Community
44.2
39.5
Facility
Community
n
ewborns not crying at birth
Assistance During ResuscitationSlide24
ENC PracticesSlide25
Variable practice levels – not aligned with training or standardsClinical competencyRetentionLack of supervisionStandard operating proceduresSupervisory system and structure
Challenges: PracticesSlide26
Preparedness: Human ResourcesThe consultant of gynecology of district hospital also described the scenario as: “To tell you the truth the baby is managed by “
Aya” here. Our nurses are busy in delivery and taking care of mother. If you go to Medical college hospitals nurses don’t even work there. All the care of the baby is taken care by Ayas.” Slide27
Quality and experience of careAbout the experience in labor room, 3 out of 4 mothers complained about the nurses not being sympathetic to the pain of the mothers. One of the mothers
said: “I was in lot of pain. They don’t understand and behave harshly. Home is better place to deliver as it is comfortable. But here people come in and out. I didn’t have any privacy.” Regarding the postnatal care, all 4 mothers mentioned they called nurses for help, but nobody responded. Two of the mothers mentioned their baby caught cold and got sick but no doctor came in for check-up until the next morning. But they also realize how busy they were and accepted it being in a govt. hospital. A mother from district hospital said: “A doctor came in the morning. He said if there was any problem. But he didn’t ask about baby’s health and didn’t examine him” Slide28
Inappropriate, inadequate human resource organization and managementQuality of careAccountabilityDignity
Challenges: Human resourcesSlide29
National responseSlide30
Essential services package
Shift towards facility delivery with continuum of careQI mechanismReal time measurement and monitoringThe next HPN Sector Program (2016-21)Slide31
Health Systems issues to focus on
HR related:Dedicated birth attendants – midwivesNumber of facilities providing delivery careHuman resourceStandardized competency based trainingQuality ImprovementSOPs (both clinical and physical standards)QI mechanism – TQM and standardsSlide32
Thank you!