Health Facility Networking for Maternal Health
|ClinicalTrials.gov Identifier: NCT01802957|
Recruitment Status : Completed
First Posted : March 4, 2013
Last Update Posted : January 28, 2015
|Condition or disease||Intervention/treatment||Phase|
|Provider Skill Provider Confidence Maternal Health Referral Systems||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||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||10787 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Health Facility Networking for Maternal Health|
|Study Start Date :||March 2013|
|Actual Primary Completion Date :||October 2014|
|Actual Study Completion Date :||December 2014|
St. Paul and Networked Health Centers
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.
Other: Training of health workers in Basic Obstetric Emergency Care
Health workers at the eight health centers will be trained in maternal, newborn, and child health (MNCH) care, including all basic emergency obstetric and neonatal care (BEmONC) signal functions and other essential MNCH services. The training is a three week competency-based curriculum developed recently by the Ethiopian Federal Ministry of Health (FMoH).Other: Hospital-health center networking system
A key intervention will be the creation of an effective, formalized networking system between Saint Paul Millennium Hospital and its eight satellite health centers in Addis Ababa. The networking system will create a conducive environment for the transfer of knowledge and skills between health care providers working at the hospital and in the health centers. Monthly review meetings will bring together staff from the hospital and health centers, and dedicated cell phones will be distributed to improve communication between the networked facilities.Other: Post Basic Emergency Obstetric Training Mentorship
At Saint Paul Millennium Hospital and the health centers, providers who have undergone BEmONC training will undergo regular monthly mentorship visits for the first six months post training. The frequency of visits after six months will be adjusted based on the retention of BEmONC skills and provider performanceOther: Team-Based Supportive supervision
Saint Paul Hospital will use team-based models to provide supportive supervision to health centers in its network. Representatives of the supportive supervision teams may, in addition to Saint Paul Hospital employees, include representatives from the Addis Ababa Regional Health Bureau.Other: Midwives exchange program
Saint Paul Millennium Hospital's maternity wards are often over-crowded and have to turn patients away. Health professionals incorrectly refer non-complicated deliveries, resulting in the occupation of beds that should be used for emergency deliveries. This action is attributed to inexperienced midwives at the health center level who are uncomfortable performing normal labor and delivery duties. In order to address this challenge, this project will establish an exchange program in which well-trained, experienced midwives from the hospitals will temporarily exchange places with less-experienced midwives in the health centers. This exchange would allow less-experienced midwives to work in the hospital environment, gaining the experience and confidence necessary to attend normal deliveries and identify appropriate referrals.Other: Strengthening the referral network
Mechanisms and protocols for smooth communication between the health centers and the hospital have been developed, allowing health centers to utilize the hospital's ambulance, and implementing mechanisms for back referrals and feedback. To facilitate this work, we will support the use of dedicated cell phones in each of the eight networked facilities and at Saint Paul Millennium Hospital, and institute referral log books at both the referring and receiving institutions.Other: Facility Checklists
Facility checklists will be used daily in each of the facilities to assess readiness for obstetric emergencies. Formally, the checklists will be used at the quarterly supportive supervision visits, to assess improvements over time.Other: Emergency Drills
Non-punitive obstetric drills will provide multiple measurable indicators of quality maternal care, will illustrate opportunities for improving facility capabilities and provider care, and will allow providers to assess appropriate referral mechanisms and facility readiness. Incorporating emergency drills into current training and at all levels of health facilities will also give providers hands-on experience
- Improved provider skill levels [ Time Frame: 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.
- Improved provider self-efficacy [ Time Frame: One Year ]Improved provider confidence will be assessed at baseline and at endline with a standardized data collection instrument.
- Increased use of effective interventions for obstetric emergencies [ Time Frame: 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 standards of care for pregnant women [ Time Frame: 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 [ Time Frame: 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.
- Sustainable, continuous quality improvement cycles through supportive supervision [ Time Frame: 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.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01802957
|Addis Ketema Health Center|
|Addis Ketema Subcity, Woreda 4, Ethiopia|
|Woreda 7 Health Center|
|Addis Ketema Subcity, Woreda 9, Addis Ababa,, 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|
|Woreda 7 Health Center|
|Gulele Subcity, Woreda 7, Ethiopia|
|Kolfe Health center|
|Kolfe sub City, Woreda 2, Addis Ababa, Ethiopia|
|Principal Investigator:||Ana Langer, MD||Harvard School of Public Health|
|Principal Investigator:||Yemane Berhane, MD, MPH, PhD||Addis Continental Institute of Public Health|
|Principal Investigator:||Delayehu Bekele, MD||Saint Paul Hospital Millennium Medical College|
|Study Director:||Fernando Althabe, MD||Institute for Clinical Effectiveness and Health Policy|