Facility Assessment Summary

Rosemary Kamunya

Activities
Physical site assessment Assessment of provider practices and competencies Provider knowledge assessment Assessment of facility supplies and medications

supply Service statistics and facility workload

The Main Goals of Facility Needs Assessments

Establish a baseline useful in realizing a program/ project plan of action to improve emergency obstetric and newborn care (EmONC) services in the three regions (Kampala Central, Western and Eastern Regions), and Guide policy, planning and prioritization to strengthen the health system using basic emergency obstetric and newborn care (BEmONC) as a point of entry.
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Background
EMONC services are needed to manage complications of childbirth and are critical to saving the lives of mothers and newborns in the developing countries and globally. Needs assessments for EmONC are health facilitybased and collect detailed information needed to plan for the improvement of EmONC services.
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Background (cont.)
Each year, roughly 350,000 women die in pregnancy and childbirth, and 4 million intrapartum and early neonatal deaths occur. Note: Many of these deaths are preventable through good-quality, accessible EmONC.

Standard Area Assessed

Antenatal care (ANC) Labor and delivery care basic Labor and delivery comprehensive Postabortion care (PAC) Other infrastructure Essential obstetric drugs and supplies HIV counseling and testing Immediate postnatal and neonatal care Postnatal clinic 68 weeks Postnatal care (PNC) in the context of HIV
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Summary of the Facility Assessment Based on Standard Area

Mpigi HC IV St Monica HC III Kalungulumira HC IV Bumanya HC IV Kyenjojo HC IV Butiiti HC III

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 Summary of the service data provided at the six facilities

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Mpigi HC IV
It was noted that the ANC revisits only captured the 4th visit based on the national HIMS, while the PNC only recorded 6 weeks, and if the woman comes after 6 weeks this was not recorded.

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St Monica HC Level III

The pie reflects the services offered in the facility. Although the ANC attendance seems to be high, the deliveries represent only a quarter in the last 3 months (December 2010February 2011). During the assessment day, there were neither clients in labor nor any delivery in the last 3 weeks. Referrals are sent to Mpigi HC IV. There is a life saving skills (LSS)-trained service provider. This facility does not offer family planning services.

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Kangulumira HC IV
The pie chart shows the integrated BEmONC services in the last 3 months. Although there is no MO or staff trained in LSS, they offer manual vacuum aspiration (MVA) services and their records are well-maintained. With proper training and provision of necessary supplies and equipment, the service providers will provide quality BEmONC services.

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Kalilo HC IV
The pie shows how the facility offers integrated BEmONC services. There is no one trained on LSS. It is worth noting that the number of PAC services is quite high in 3 months. With training of service providers and provision of equipment and supplies, the facility can adequately provide comprehensive BEmONC.

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Kyenjojo HC IV
It was noted with concern that the health facility, although level IV, does not offer PAC services, and the theatre has not been in operation for the last 3 or more years; any emergencies are referred to Fort Portal. At the time of the visit, only 1 woman was in the ward waiting and no delivery conducted in the last week. No one is trained on LSS. Although the ANC clientele is high, deliveries amount to only one-quarter.

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Butiiti HC III
The facility offers BEmONC services. There is no staff trained on LSS. There is no theatre, hence some of the services, especially C-section, are not offered. If trained and with extra equipment, the facility will be able to offer quality BEmONC services.

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Recommendations - 1
EQUIPMENT 1. 2. BP machines BEmONC equipment, e.g., delivery and PAC kits, speculums, sponge-holding forceps, Ambu bags, examination lamps for theatre, ANC, labor wards and postnatal care, etc. Theatre equipment to include oxygen and suction machines Examination beds and PAC coaches Fridges to store blood 1. SUPPLIES & DRUGS Emergency drugs for BEmONC in the labor ward and theatre Infection prevention (IP) equipment, e.g., chlorine, buckets, utility gloves, aprons, boots, etc. IEC materials both for clients, HE and job aids, clients rights poster RENOVATIONS If funds are available: 1. Kalilo ANC, labor ward, PAC and examination room waiting areas, etc. 2. Butiiti - waiting areas for ANC, PNC, OPD, labor ward 3. Mpigi Labor ward, waiting area in the maternity and ANC clinics 4. Reorganize Kangulumira 5. Put up curtains or screens to all facilities to ensure privacy 6. Help put up signs to indicate services offered in each of the areas TRAINING On BEmONC, IP, DFD: 1. Health care providers, and where there is a shortage, the midwife assistants 2. Update the vocal persons 3. Identify and update/trainprec eptors for onthe-job training

2.

3.

3.

4. 5.

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Recommendations - 2
An experienced Medical Officer (MO) to work with the doctor in Kyenjojo to acquire/be updated on BEmONC skills. Assessment tool used during the assessment to be distributed to all the facilities/units as job aids to ensure quality BEmONC. The facility will conduct regular self-assessment of the quality of services they are offering. The same tool can be used during supportive supervision. Lobby for a MO for Kangulumira HC IV. All facilities to be encouraged to focus on having integrated services (ANC, PNC, HIV and other services) on a daily basis, i.e., Monday through Friday. STRIDES to look into ways of capturing: All the ANC clients as opposed to capturing only the first and fourth visits Clients who come to the facility for PNC services after the sixth week
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Training Skills/Clinical Training Skills for BEmONC - 1

Training details: The dates: April 1115 for Training Skills (TS) for BEmONC April 1830 training of health care providers in the three regions Trainers: RK, KM, EB Participants: 15; 5 from each region Selection criteria of the trainers: Already training in field of RH/MNH Have knowledge and skills in BEmONC/LSS Ready and committed to train others Have support from their supervisor Venue for TS/CTS training to be communicated but must be near a facility with high client load of deliveries
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Training Skills/Clinical Training Skills for BEmONC - 2

Materials for training Clinical Training Skills (CTS) trainers manual for the trainers BEmONC participants guide has all the learning guides and checklists Handout of the PowerPoints NeoNatalie and MamaNatalie anatomic models, in addition to DVD on stitching and tying knots, delivering when squatting During both the TS and health provider training, orient/ sensitize participants on the assessment tool/job aid so they will support their regional facilities. Practicum site/s for the TS/CTS for the trainers to practice BEmONC in preparation of the training
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Acknowledgments
Directors of the various districts District Health Officers and EmONC vocal persons from the 3 regions (Kampala Central, Western and Eastern Regions) of Uganda Service providers who assisted during the assessment period for their cooperation and time STRIDES COP and the entire STRIDES team including the drivers Jhpiego Baltimore, Uganda and Kenya
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