#1Nine steps to success in Burkina Faso The Neonatal Essential Survival Technology (NEST) program Paul Ouedraogo Director of the Saint Camille Hospital in Ouagadougou Assistant at the Catholic University of Saint Thomas D'Acquin HOPITAL SAINT CAM DE OUAGADOUGOU HOSCO nest Neonatal Essential Survival Technology Chiesi FOUNDATION SURVIVE and THRIVE: Transforming care for every small and sick newborn #EveryNewborn #EveryChild Alive#2CHAPTER 3. Deliver the care they are entitled to Saint Camille Hospital, Ouagadougou (HOSCO) • Founded in 1967 by the Order of St. Camillus (Camillian Fathers) • Neonatal unit opened in 1974 The situation and gaps in 2014 о Lack of space and increasing number of admissions о Limited presence of qualified staff (1 head nurse + 5 nurses and 16 nursing assistants/ancillaries and no medical staff - day time cover if required from trainees on paediatric ward) Lack of adequate technologies • о High number of outborn babies (2014:86% outborn of 1900 admissions) о о High neonatal mortality (2014: 43% neonatal mortality rate, 67% VLBW mortality) Collaboration with external associations and experts but not coordinated Need of a more structured approach to improve the care for neonates SURVIVE and THRIVE: Transforming care for every small and sick newborn 2004 2014 HOPITAL SA IT CAMILLE DE OUAGADO HOSCO#3CHAPTER 3. Deliver the care they are entitled to HOSCO and NEST partnership - 2014 onwards Assessment of the needs Evaluate needs of hospital in terms of neonatal care, in particular for sick and low birth weight newborns Monitoring Implement a system of data recording and management (statistics, medical records, etc.) Layout and organization Set up the best possible neonatal unit in a hospital with limited resources Network and collaboration Create a network with other hospitals and birth centres nest Neonatal Essential Survival Technology Set of basic products Identify essential drugs and basic equipment for neonatal care, in terms of simplicity, adaptability, costs and maintenance Guidelines and protocols Develop a set of protocols, manuals and guidelines for the local hospitals Training on the job Increase competencies of local staff already in neonatal units, through bedside training With the support, coordination and management by the Chiesi Foundation Empowerment and recognition Empower parents and families Value the role of the neonatal nurse Master programme in neonatology Train dedicated and specialized nurses and doctors SURVIVE and THRIVE: Transforming care for every small and sick newborn HOPITAL SA IT CAMILLE DE OUAGADO HOSCO #EveryNewborn #EveryChild Alive#4CHAPTER 3. Deliver the care they are entitled to HOSCO – assessment of needs in 2016-2018 - • Buildings and facilities • People – staff, mothers and families - Equipment and drugs. • Networking and Collaboration. Involvement of higher-level institutions within Burkina Faso Examples of tools adopted for the assessments World Health Organization REGIONAL OFFICE FOR Europe Hospital care for mothers and newborn babies: quality assessment and improvement tool WHO Model List of Essential Medicines for Children A systematic standard based participatory approach Second Edition (2014) SURVIVE and THRIVE: Transforming care for every small and sick newborn 5th List (April 2015) #EveryNewborn #EveryChild Alive#58 7 6 5 AS 4 The new neonatal care unit - April 2017 • Additional space and new organisation of the rooms according to severity (intensive, semi- intensive, pre-discharge) • . Room dedicated to mothers for breastfeeding Gradually introduction of new technologies (jaundice, CPAP), oxygen (each cot with medical gases) and hygiene device's • New organizational model for the staff to guarantee team working, coordination and presence Yearly training program developed by the staff, with the support of external experts SAINT CAMILLE DE OUAGADO HOSCO sick newborn #EveryNewborn #EveryChild Alive#6CHAPTER 3. Deliver the care they are entitled to New unit dedicated to KMC, mothers and families L 口 9 2017 - dedicated KMC room 2018 dedicated staff to KMC room - - 2019 mothers access to the neonatal care unit #EveryNewborn #EveryChild Alive SURVIVE and THRIVE: Transforming care for every small and sick newborn HOPITAL SA IT CAMILLE DE OUAGADO HOSCO#7CHAPTER 3. Deliver the care they are entitled to Technology and training EQUIPMENT List of appropriate neonatal care equipment Proved efficacy о о Low need for maintenance о User friendliness о Low cost Adaptability to local conditions Plan to gradually introduce new equipment • Development of a training package to ensure safe use and maintenance for each device TRAINING • Simple and practical training materials developed with specific attention to the role of the neonatal nurse • "Train the trainers" approach Involvement of a team of external experts on the basis of an yearly training program • Frontal and bedside trainings Referring hospitals and birth centers now sending staff for training SURVIVE and THRIVE: Transforming care for every small and BirthLink Essential Care nest Neonatal Essential Survival Technol An Overview of Fundamental principles of neonatal care Warm, Sweet, Pink & Safe Admission of baby Small & preterm baby Sick baby after delivery Admission from home or health centre They all need the same essential, basic care Warm, Sweet, Pink & Safe BirthLink BirthLink 36.5-37.5 °C Chi www.birthlinkuk.org FOUND °C 40.0 ----ויויזיויו Severe Hyperthermia Hyperthermia 37.5 36.5 36.0 NORMAL Mild Hypothermia Moderate Hypothermia 32.0 Severe Hypothermia#8CHAPTER 3. Deliver the care they are entitled to Preconditions for the success and sustainability of the plan Financial sustainability - Support to complete other hospitals departments (e.g. Imagerie) that can contribute to sustain the costs of the neonatal care unit - Efficiency and savings (e.g. solar panels on the neonatal care unit) Skilled and reinforced staff and empowerment of mothers and families - Nurses: in 2019 12 per shift (14 total) +24 nursing aids (3-4 per shift) - Doctors: from 1 general practitioner to 2 general practitioner and 1 paediatric specialist - Mothers and Families: KMC fully implemented and in 2019 - mothers and families access to the unit Collaboration - With international organisations and experts - With the other hospitals. and birth centres (Perinatal Network) - With institutions SURVIVE and THRIVE: Transforming care for every small and sick newborn #EveryNewborn #EveryChild Alive HOPITAL SA IT CAMILLE DE OUAGADO HOSCO#9CHAPTER 3. Deliver the care they are entitled to Next steps Strengthen the data collection system to better understand the causes of mortality and deliver specific quality improvement interventions • Establish a functional Perinatal Network in Ouagadougou • Expand the training program at HOSCO and for the Perinatal Network • Reinforce the engagement of the institutions О Ministry of Health Société Burkinabe de Pédiatrie (SOBUPED) • Promote a formal neonatal nurse qualification (Master) CAINT CAMILLE HOPITAL SAL DE OUAGA f HOSCO SURVIVE and THRIVE: Transforming care for every small and sick newborn #EveryNewborn #EveryChild Alive