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PROJECT IN PROGRESS

Training of trainers for health professionals

During project implementation 15 batches of trainings of trainers (ToT) were organized and 665 Health professionals (obstetrician, neonatologists, paediatricians and MCH managers were trained as a trainers. The target of ToTs and trainers exceeded by 52%

PROJECT COORDINATION

Seven quarterly meetings of the Project Steering Committee (PSC) were held. These meetings were chaired by Deputy Minister of Health. The meetings discussed and reviewed the progress made by the project. The PSC approved the quarterly reports. The report of the external monitoring was shared with members of PSC.

The current project is one of many in the overall mother and child healthcare' sector and all these projects have a connection with the MoH as a partner. Through the PSC of the current project, and at the project team's initiative, the MoH coordinates donor’s interventions in health sector. The PSC has become the platform for all donors and development partners for deliberation and consensus building on health sector investment and reform while keeping the MoH in the driving seat. The MoH has recognized the PSC as an important vehicle for donor coordination and harmonization of resources mobilized in the health sector. MoH and other partners in principle have agreed to continue the donor - partner coordination mechanism established by the project beyond the duration of the project.

Training on newborn resuscitation and essential newborn care 

The training of health providers (neonatologists, obstetricians and midwives) on newborn resuscitation and essential newborn care (NR/ENC) started in April 2009 as planned. During the project implementation 1558 health providers were trained in Newborn resuscitation/Essential Newborn care. Training completed in Surkhandarya (308 health providers), Kashkadarya (316 health providers), Sardariya (201 health providers) and Djizak (225 health providers) Oblasts. In Samarkand (214 health providers out 430) and Navoi (188 health providers out of 250), Namangan (56 health providers out of 400) and Andijan (50 health providers out of 450) are trained.

Post Training Monitoring

The Post training monitoring has been completed in the 48 maternities of the six Oblasts. Out of 1,040 health providers trained in these maternities, 764 (78%) were monitored to assess their skills.

The core indicators and result of the monitoring is given in the table below

Table 3: Results of post training monitoring – NR/ENC

Core indicators	HP correctly practise skills No           %
HP who could correctly conduct full examination of the newborn baby following the protocol.	670	64
HP who could correctly conduct resuscitation of the newborn babies as per the protocol.	509	49
HP who could correctly conduct treatment of neonatal infection as per the protocol.	300	29
HP who could correctly manage birth asphyxia as per the protocol.	314	30
Average percentage of HP who could practise the core indicators	448	43

The first round of monitoring shows that there are still challenges to correctly manage the cases of birth asphyxia and control of neonatal infection. This issue has been extensively discussed with trainers and course director. It has been agreed to give more time to teach these skills during the trainings and to conduct skill reinforcement during the subsequent post training monitoring.

Figure 3: Percentage of health providers who correctly practised NR/ENC core indicators.

Training on effective perinatal care
The training of health providers (neonatologists, obstetricians and midwives) in Effective Perinatal Care (EPC) started in May 2009. Total 244 health care providers were trained on IMSCHS project.
The health providers from 35 maternities took part in the trainings which were conducted by both national and international trainers. The participation of international trainers (obstetricians, neonatologists and midwives) has helped to improve the confidence and capacity of national trainers to conduct EPC in future.

The training completed in Djizak (36 health providers), Navoi (38 health providers), Syrdariya (37 health providers) and Surkhandarya (96 health providers) Oblasts. In Samarkand (36 health providers out of 84) and Namangan (37 health providers out of 60), are trained.

Child survival package

Total 1114 health providers were trained on Baby Friendly Health Initiatives

The post training monitoring and evaluation for certification to Baby Friendly Hospital Initiatives (BFHI) was completed in Djizak and Syrdariya Oblasts. In Syrdariya Oblast, 1 maternity, 3 maternity wards, 2 polyclinics and 7 SVPs are certificated as BFHII. In Djizak Oblast 1 maternity, 6 maternity wards, 3 polyclinics and 12 SVPs are certificated as BFHII. In total 2 maternities, 9 maternity wards, 5 polyclinics and 19 SVP certificated as BFHII. The first round of BFHI monitoring in 27 maternity wards, 6 maternities, 27 Polyclinics and 32 SVPS has been completed in Andijan and Namangan Oblasts.

The Oblast level training for primary healthcare workers (GPs and nurses) on the child survival package (primary IMCI, growth monitoring and breast feeding) started in April 2009 as planned. 2,485 health providers (GP doctors 1,060 and nurses 1,425) were trained in primary IMCI/CIMCI, thus, 65% of the target is achieved. Follow up after training (FUAT) as a part of post training monitoring was completed in Syrdariya, Samarkand, Kashkadarya, Navoi, and Namangan Oblasts. The trainers conducted the post training monitoring in 210 SVPS and Polyclinics.

Table 5: Results of post training monitoring – PIMCI

Core indicators	HP correctly practise skills No              %
GP doctors who could correctly assess the danger signs in sick children	288	80%
GP doctors who could correctly assess three main symptoms (cough, diarrhoea and fever) in sick children.	313	87%
GP doctors who could correctly assess the nutritional status of the child	252	70%
GP doctors who could correctly check the weight of child and interpret in the growth curve.	194	54 %
GP doctors who could correctly assess the immunization status of the child	306	85 %
Average percentage of GP doctors who could correctly practise core indicators of PIMCI	273	76%

Growth and Development Monitoring (GDM) and Breast Feeding (BF) Counselling

Total 2,211 health providers (GP doctors and nurses) were trained in Growth and Development Monitoring (GDM). 2,211 health providers (GP doctors and nurses) were trained in breast feeding counselling course as part of Infant and Young Child Feeding (IYCF). Follow up after training (FUAT) as a part of post training monitoring was completed in Andijan, Namangan, Sardariya and Djizak Oblasts. The trainers conducted post training follow up in 663 primary health facilities. Out of 2,211 GP doctors and nurses who were trained on GDM and BF counselling course, 1,451 ( 66%) were monitored for their skills.

QUALITY ASSURANCE IN HOSPITALS
WHO tools - Quality of hospital care for mothers and newborn babies (QoMNHC) were introduced in IMCHS project localities. Rapid assessment by using this tool was conducted in Republican Perinatal Center and its branches in Djizak and Samarkand. Three international consultants and 12 national trainers took part in the assessment as a part of first phase of piloting the CQI tool. On job training for 12 national trainers was organized by the three international consultants. In March 2010, 24 Oblast trainers were trained by the international consultant. The assessment and training on QOMNHC is ongoing. It has been already piloted in five maternities in Samarkand, Sardariya, Djizak, Kashkadarya and Namangan. 104 health providers (neonatologists, obstetricians and maternity nurses) from these maternities were trained in QOMNHC. Detail plan for quality improvement were developed for each maternity. Pre and post training questionnaire showed average pre test score 24% and post test score 63%.

IMPLEMENTATION OF ILBD
Orientation sessions on ILBD were organised before conducting training at the Oblast level. A total of 960 Health Providers (neonatologists, obstetricians, midwives and statisticians) were trained from 9 Oblasts. Pre and post test score of 727 participants was randomly selected and analysed. The average pre test score for these trained participants was 65 and post test their score was 91. Out of these trained health providers 94% (683 participants) scored more than 75 in the post training competency test.

Health management training
In total 997 managers were trained and 82% of target achieved and post training monitoring is in progress. Following the recommendation of ROM, three experience sharing collegiums of health managers were organized in Samarkand, Namangan and Khoriezm Oblasts. During these experience sharing collegiums the MCH managers shared the key MCH indicators improvement in their Oblasts.

Sharing of Experience in MCH Managers Collegiums

Khorezm - Urgench Oblast Perinatal Centre. Experience sharing collegium on “Effective use of perinatal technologies” was organized in Urgench. Sixty MCH managers including MOH representatives, neonatologists, obstetricians and directors of perinatal centers attended the collegiums. Topics of presentations and experience sharing:
• Effective peri-natal technologies;
• International Live Birth Definition (ILBD) and BABIES;
• Quality Assurance System and experience of piloting QOMNHC;
Results:
• Data from all maternities implementing effective peri-natal technologies reduction of neonatal mortality were presented.
• The quality of services has increased in all maternities
• Overall management and implementation of newborn care methodologies have improved.
• Reporting system on peri-natal outcome by using ILBD and BABIES matrix has shown correct recording of peri-natal conditions at par to the international standards.
• Initial assessment of use of QOMNHC tools in five maternities has brought positive changes on maternal and newborn care.

Samarkand and Namangan Oblast Multi-profile Children Hospital. Experience sharing collegiums on implementation of “Integrated Management of Childhood Illnesses (IMCI)” were held in Samarkand and Namangan Oblast Mutli-profile Children Hospital. Representatives of Ministry of Health, Maternal and Child health Department, Chief Doctors, Chief pediatricians and MCH managers participated in these collegiums. Objectives of collegiums:

• To share the experience of implementation Hospital IMCI and Primary IMCI in IMCHS Project Oblasts
• To review the current status of implementation of MoH Decree no 155 on Hospital IMCI and its impact on under five morbidity and mortality due to common childhood illnesses.

Results:
• The data of childhood morbidity and mortality of different children hospitals were shared. Data showed impressive results on reducing duration of illnesses, reduction on use of multiple drugs/ injections (Poly pharmacy) and mortality.
• Triage system for child admission and care at the emergency department was established.
• Provision of essential drugs, oxygen, equipments and posting of staff was improved.
• All inpatient treatments were carried out following the standard protocol of Hospital IMCI.
• All participants agreed that implementation of hospital IMCI has improved the quality of care in their hospitals and they are making saving especially by less using drugs, IV fluids, injections and less duration of hospitalization.

Challenges:
• They key challenges were the less supply of emergency equipments and essential drugs to practice IMCI at the primary health care facilities.
• Monitoring and supervision was also another challenge due to limited skills of health managers to conduct IMCI monitoring. But this is overcoming after gradual implementation of follow up after training monitoring.
• Number of health providers trained is very limited. So there is increased need to train other health providers to effectively practice IMCI.


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