Health Facility Networking for Maternal Health

Not Applicable

Completed

• Conditions: Provider Skill; Referral Systems; Maternal Health; Provider Confidence
• Interventions: Other: Training of health workers in Basic Obstetric Emergency Care; Other: Hospital-health center networking system; Other: Post Basic Emergency Obstetric Training Mentorship; Other: Team-Based Supportive supervision; Other: Midwives exchange program; Other: Strengthening the referral network; Other: Facility Checklists; Other: Emergency Drills

• Registration Number: NCT01802957
• Lead Sponsor: Harvard School of Public Health (HSPH)

Brief Summary

This study will introduce a multi-faceted intervention package which will be implemented in the newly developed network of St. Paul's Hospital Millennium Medical College (St. Paul) and the surrounding seven satellite health centers. The goal is to assess if this group of interventions improve the skills and confidence of providers to handle obstetric emergencies, if they streamline the referral process and if they result in improved maternal/newborn health outcomes.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2013-02-28
• Study Start: 2013-03
• Study First Submitted QC: 2013-03-01
• Study First Posted: 2013-03-04
• Primary Completion: 2014-10
• Study Completion: 2014-12
• Status Verified: 2015-01
• Last Update Submitted: 2015-01-26
• Last Update Posted: 2015-01-28

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 10787

Inclusion Criteria

Sample population for each data collection instrument:

Baseline/Endline:

Key Informant Interviews:

• St. Paul hospital: Maternal Child Health (MCH) Head, Midwife/nurse from Labor and Delivery (L&D), Midwife/nurse from Emergency
• Health Centers: Medical Director, Head of MCH (midwife) Midwife from L&D, Referral focal person

Health Facility Assessment:

• Manager/most senior health worker asked (one from each facility)

Provider Survey:

• All providers in the MCH at both the hospital and health center level

Chart review:

• All deliveries in all centers will be screened during the intervention phase. Data on every birth will be collected from the log books of each facility. The data collector will then find the medical record of that patient to assess the Standard of Care (SOC) during Ante-natal care (ANC)- if available from the chart, L&D and screen for an obstetric complication. If there was a complication, the near miss data will be collected.

Telephone registration log book:

• all phone calls between HC and Hospital

Facility Checklists:

• Forms completed by Supportive Supervision Teams at quarterly visits

Standardized BEmONC training evaluation

• Will be given to every provider undergoing the training, as part of the training curriculum.

Monthly mentoring evaluations - for the six months post-training mentorship, for all providers who have undergone BEmONC training.

Supportive Supervision Gap Identification Checklists

• Collected quarterly from each of the 9 facilities

Exclusion Criteria

Not provided

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
St. Paul and Networked Health Centers	Training of health workers in Basic Obstetric Emergency Care	An uncontrolled before and after design with baseline and follow-up cross sectional measurements will be used at the overall site level (St. Paul Hospital and the 8 associated HCs). There will be no control unit.
St. Paul and Networked Health Centers	Emergency Drills	An uncontrolled before and after design with baseline and follow-up cross sectional measurements will be used at the overall site level (St. Paul Hospital and the 8 associated HCs). There will be no control unit.
St. Paul and Networked Health Centers	Hospital-health center networking system	An uncontrolled before and after design with baseline and follow-up cross sectional measurements will be used at the overall site level (St. Paul Hospital and the 8 associated HCs). There will be no control unit.
St. Paul and Networked Health Centers	Midwives exchange program	An uncontrolled before and after design with baseline and follow-up cross sectional measurements will be used at the overall site level (St. Paul Hospital and the 8 associated HCs). There will be no control unit.
St. Paul and Networked Health Centers	Post Basic Emergency Obstetric Training Mentorship	An uncontrolled before and after design with baseline and follow-up cross sectional measurements will be used at the overall site level (St. Paul Hospital and the 8 associated HCs). There will be no control unit.
St. Paul and Networked Health Centers	Team-Based Supportive supervision	An uncontrolled before and after design with baseline and follow-up cross sectional measurements will be used at the overall site level (St. Paul Hospital and the 8 associated HCs). There will be no control unit.
St. Paul and Networked Health Centers	Strengthening the referral network	An uncontrolled before and after design with baseline and follow-up cross sectional measurements will be used at the overall site level (St. Paul Hospital and the 8 associated HCs). There will be no control unit.
St. Paul and Networked Health Centers	Facility Checklists	An uncontrolled before and after design with baseline and follow-up cross sectional measurements will be used at the overall site level (St. Paul Hospital and the 8 associated HCs). There will be no control unit.

Primary Outcome Measures

Name	Time	Method
Improved provider skill levels	One Year	Provider skill will be measured through baseline and endline evaluations, mentoring reports, and the standardized evaluations used in the Basic Emergency Obstetric Care trainings.
Increased use of effective interventions for obstetric emergencies	One Year	Continuous data extraction from patient charts will be used to assess the appropriate treatment for obstetric emergencies over the study period. Additionally changes in time-to-treatment for post-partum hemorrhage and pre-eclampsia/eclampsia cases will also be assessed from patient charts.
Improved provider self-efficacy	One Year	Improved provider confidence will be assessed at baseline and at endline with a standardized data collection instrument.
Improved standards of care for pregnant women	One Year	Continuous extraction from patient records throughout the study period will be used to assess the trends in the Standards of Care (SOC) for Ante-natal (ANC), and care during Labor and Delivery.
Improved Referral Systems	One Year	* Decreases the proportion of referrals made without proper prior communication to the receiving health facility; * Formalized feedback mechanisms between Saint Paul and the Health Centers; * Decreased number of inappropriate referrals from Health Centers to St. Paul; * Appropriate back-referrals from St. Paul to Health Centers; Data on Health Center/Hospital communication and referrals will be collected through phone logs, and referral sheets.

Secondary Outcome Measures

Name	Time	Method
Sustainable, continuous quality improvement cycles through supportive supervision	One year	Quarterly, a supportive supervision team will visit each of the health facilities involved in this study, and, using a checklist and a participatory approach, will identify areas to improve the quality of care provided. Each action item will will have a person assigned to it, and a plan to resolve the issue. Follow up supportive supervision visits will begin with an assessment of the previous visit's action plan, and then work to identify new areas for quality improvement. This process is iterative.

Trial Locations

Locations (7)

Addis Ketema Health Center; 🇪🇹 Addis Ketema Subcity, Woreda 4, Ethiopia

Woreda 7 Health Center; 🇪🇹 Gulele Subcity, Woreda 7, Ethiopia

Semen Health Center; 🇪🇹 Arada Sub City, Addis Ababa, Ethiopia

Selam Health Center; 🇪🇹 Gulele Sub City, Woreda 9, Addis Ababa, Ethiopia

St. Paul Hospital Millennium Medical College; 🇪🇹 Gulele Subcity, Addis Ababa, Ethiopia

Shegole Health Center; 🇪🇹 Gulele Subcity, Woreda 10, Addis Ababa, Ethiopia

Kolfe Health center; 🇪🇹 Kolfe sub City, Woreda 2, Addis Ababa, Ethiopia