Kisumu county MPDSR process Integrating Action planning Matrix

Kisumu county MPDSR process: Integrating Action planning Matrix. Jane Owuor 1, James Otieno 1, Nelly Rangara 1, Evans Ondura 3 The work presented here has been supported by the United States Agency for International Development (USAID) under the terms of Health Informatics, Governance and Data Analytics (HIGDA) Project - Award AID-615 -A-16 -00007 The Views expressed are not necessarily those of USAID or the United States government. Background Action Planning Matrix Success The Government of Kenya has established a goal to reduce the countrywide maternal mortality rate to 200 per 100, 000 live births by 2030. The global goal for the SDGs - By 2030, reduce the global maternal mortality ratio to less than 70 per 100, 000 live births Maternal and Perinatal Death Surveillance and Response (MPDSR) is a systematic, multi-level process for confidentially reviewing each maternal and perinatal death or ‘near miss to; Understand what went wrong, Learn from mistakes in a ‘noblame’ environment, Take steps to ensure that it doesn’t happen again, Strengthen teamwork at all levels to improve the quality of maternity services, and Celebrate successes in reducing maternal and Perinatal mortalities. • Formation of Blood Transfusion TWG. That addresses issues of blood security and safety. • Improvement on reporting and auditing of maternal deaths and uploading to DHIS. • Gradual reduction of maternal deaths from the year 2015 to date. • JOOTRH granted authority to employ 60 nurses to ease shortage in Maternity • KCH granted authority to engage midwives on locum in maternity to ease staff shortage. • County Procured 6 portable ultrasound machines to be used in Ante Natal Clinics. ANC Mothers need to have at least one ultrasonic exam. • Improvement in Referral; County purchased eight Ambulances and appointed a focal person to improve on referral. • Meeting of County Health Leaders from Siaya, Vihiga, Homa Bay , Migori to streamline Referral • Increase in Bemonc Facilities from 17 to 38 • Increase in GOK CEMONC Facilities from 2 to 3 Ahero CH and plans under way to open a 4 th one in Muhoroni and construct others in all sub counties. • Increased staffing, Medical officers, nurses at Ahero CH • Operation research on Maternal mortalities; Data currently being analysed • Integration of updates /capacity building in the meetings Problem • Every year in Kenya more than 7000 women die during pregnancy, childbirth or shortly after delivery, while perinatal deaths (stillbirths and deaths during the first week of life) number in the tens of thousands. Only a fraction of these deaths are recorded in the District Health Information System (DHIS). • Kisumu is one of the counties in Kenya with a particularly high burden of maternal and perinatal deaths. • Kisumu: MMR = 597/100, 000 Live Births (Kenya= 362/100, 000 LB) • Kisumu is among the 15 Counties (out of 47 )in Kenya contributing 98. 7% of total maternal deaths Kisumu County MPDSR Progress Maternal Deaths reported and audited • Governors’ Communique of 2015 • Commitment by the top leaders to personally attend the meetings. • Need to know why women are still dying in high numbers Maternal Deaths reported and audited Trend Maternal Deaths Audited Maternal Deaths Not Audited %Audited 70 97% 60 50 The Kisumu MPDSR Process 95% 74% 40 30 20 7% 10 0 Year 2015 Year 2016 Fig 3. 0. Maternal deaths audited Action Tracking Matrix/ Performance Improvement Plan Nr. Date Reporting Period Action Points Year 2017 Year(Jan-Jun) 2018 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Achievements • Openness and trust to talk about MPDs during MPDR meetings • Health workers are not penalized (removal of health workers’ fear) • Focus on improving healthcare systems and quality of care. • MPDRS guidelines domesticated by the County. • Regular MPDR meetings on county, sub-county and hospital levels • Improved reporting. Since July 2015, all MPDs are reported and reviewed. • Involvement of Regional Blood Transfusion Unit: Led to formation of blood transfusion committee • Involvement of Partners • Involvement of private health sector (Agha Khan Kisumu, Nyabondo Mission Hospital, Maseno Mission Hospital) among others. • Focus on Response: up to date, 65% of Action Points determined at County MPDR Meetings achieved Lessons Learnt Fig 1. 0: Showing the MPDSR Process Action Plan Maternal Deaths reported and audited Achievement Status of Action Points Actio n Status Point (Narrative) (Enumerative) s Total Timely 29 - 30 -Sep Responsible Timeframe 29 -Aug-16 30 -Sep-16 Aug- -16 16 JOORTH and Report next Complete 1 1 1 KCH meeting 1 29 -May First meeting Facility -15 (introduction) MPDR Committee Meeting. 2 29 -May First meeting Sub-county MOHs Report next Complete -15 (introduction) MNP Death meeting Review Committee Meeting 3 29 -May First meeting Review all JOORTH and Report next Complete -15 (introduction) MNP deaths KCH meeting that occur in the facilities 1 0 1 1 1 1 Fig 2. 0: Action Tracking Matrix/Performance Improvement Plan At the beginning of every meeting. The Action points from the last MPDSR Meeting are reviewed. The progress of implementation determined At the end of the meeting New action points are added to the previous action points with clear timelines. • MPDs occur as a result of the three delays in seeking care. • Haemorhage, Sepsis, PET are leading causes. • Underlying causes for mortality include barriers such as ignorance, financial, geographical, security, infrastructural • Monitoring and evaluation through regular mortality data review is key to performance improvement • There is need to strengthen the response part of MPDSR • Commitment by top leadership is key to success. Kisumu County CECm for Health & Sanitation, Dr Rosemary Obara addressing participants during Obstetric Ultrasound training. One of the actions from MPDSR Action planning matrix. Acknowledgements Kisumu County Health Leadership, CEC, COH , CDH, COG, LREB Palladium; Tupime County, HIGDA, GIZ, MCSP Measure Evaluation-Pima Afya Halisi, KMET CHMT, SCHMTs, Facilities Obstetricians, Pediatricians, HCWs