Post on 31-May-2020
THE JHPIEGO STORY
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Saving Lives from Day OneThe Jhpiego Story
1 out of every 24 babies in Ghana will die before their first birthday.
The struggle to give babies a chance at a healthy life is
truly global. Around the world, 1.1 million newborns die
in their first months of life. The fight to stem the tides
of these deaths is fiercest in Sub-Saharan Africa, where
the newborn mortality rate is highest. As of 2014, out of
1,000 live births, it’s estimated that 41 newborns born in
the region don’t survive.1
Ghana’s infant mortality rate is currently 59th highest in
the world.2 Routinely, newborns die in the first 24 hours
after birth from completely preventable conditions, such
as malaria, sepsis and common infections. Three out of
four Ghanaian babies are born in public health facilities,
attended by midwives, nurses, or other skilled birth
attendants. The number of babies born in facilities has
increased from 14 percent in 1993 to 73 percent in 2014.3
GhanaAFRICA
THE JHPIEGO STORY
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Meet Jhpiego
Created in 1974 as the Johns Hopkins Program for
International Education in Gynecology and Obstetrics,
Jhpiego is a non-profit healthcare organization dedicated
to saving the lives of women and their families in
developing countries. “Jhpiego’s ultimate goal is
sustainability -- leaving behind a well-prepared network
of health care professionals and a strong foundation that
they can build upon when we move on.”4
“Our main focus is to deal with newborn mortality reduction first and foremost, then to reduce stillbirth rates and to abet midwives and providers with skills and knowledge.”
Amos Asiedu Monitoring, Evaluation and Research Officer for Jhpiego
Project Fives Alive! was a program sponsored by the
Ghana Health Service and supported by the Institute
for Healthcare Improvement (IHI) and other partners,
designed to reduce the mortality rate of children aged
five and under through provider training. The program
was a resounding success, decreasing the death rate for
Ghanaian children under five by 32 percent in a five-year
period.5 The IHI described the initiative’s central idea
this way: “Project Fives Alive! emphasizes the use of
local data and local innovation by the frontline providers
who are closest to the processes, thus improving their
capacity for data analysis, data-driven decision-making,
and local ownership of health outcomes.”6
Despite that triumph, Ghana’s newborn mortality rate
was deeply troubling. Babies were dying in the 24- to
72-hour post-birth window from a lack of postnatal
care. Jhpiego adopted the IHI platform for a specialized
newborn program that would offer competency training
that could be scaled to meet the needs of facilities
of every size, in every region, whether in a big city or
remote village. In 2013, Jhpiego received funding from
the Bill and Melinda Gates Foundation for the ambitious
Jhpiego’s inspiration: Project Fives Alive!
three-year program, which would give midwives, nurses
and doctors the knowledge they needed to deliver
immediate, high-quality postnatal care and prevent these
tragic, needless deaths.7
A network of over 100 tutors, equipped with innovative
teaching methods and basic supplies, began delivering
their evidence-based knowledge to the field, instructing
trainees who would in turn pass along their new skills,
creating a culture of ongoing learning. Reducing the
newborn mortality rate in the first 24 hours of life by 25
percent at 110 health facilities in 10 regions of Ghana is
the goal of Jhpiego’s massive three-year effort.
THE JHPIEGO STORY
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The miracle of evidence-based care Evidence-based care combines the most current clinical
expertise and reliable scientific evidence with the
individual needs of the mother and baby. Often, folk
wisdom and personal beliefs heavily influence maternity
practices; by teaching evidence-based practices, local
midwives and nurses who previously couldn’t access the
most current clinical methods are “learning by doing,”
quickly increasing their competence – and saving more
little ones.
“We train providers for a week, and then we give them
one month to practice,” explains Jhpiego’s Monitoring,
Evaluation and Research Officer, Amos Asiedu. “After that
we go again to train them, and then, after they practice for
a year we assess them again.” Additionally, the program
monitors service data to make sure the project is moving
in the right direction. Complications, fresh stillbirth rates
and maternal death rates are also tracked. Pre and post-
training results are compared, and in addition to giving
a picture of each provider’s progress, results are used
to gauge the effectiveness of the program as a whole.
Providers fill out specialized knowledge tests and objective
structured clinical examinations assessments (OSCE) on
paper forms.
At the program’s outset, in addition to completing
documentation by hand, trainees were tasked with doing
their own data entry. The burden of doing double entries
(once on paper forms, then computerizing the same data
manually) increased the possibility for mistakes. And, the
amount of time it was taking for results to come in from
the field was holding the research team back from doing
the analysis they needed to keep the program on track.
“Initially, those who were in training entered the data
themselves. But we realized that they also had to
concentrate on their training in the field,” Amos recalls.
For the first two rounds of the program, training was
done for 28 facilities, generating about 22,000 completed
assessment questionnaires. Both the knowledge
assessment and OSCE are multiple page reports that
require providers to answer anywhere from 50 to 75
questions. “In fact, that was very huge work for us to do,”
he explains. “We had a lot of backlog because we were not
able to get someone to enter for us, and even if someone
was to do it manually, it had to be a double entry. And that
was where the challenge was.” Accurate, quality data was
needed as fast as possible to help program leaders assess
its effectiveness, and to help them make any needed
changes.
Ghana’s lifesavers were drowning in data
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At last, a workable alternative If the midwives and nurses were no longer taking the
hours needed to input data from their forms, what was the
plan? “Actually, the only thing I had in mind was to hire a
lot of data collectors to go collect our data,” Amos says.
“That was the only option we had until (Jhpiego colleague)
Ms. Allyson Nelson came out and said, ‘What’s going to
help us cut down our manual data input and the people
trying to scan it?’ And that was when the whole team sat
down and considered Captricity.”
Because the trainees were initially entering their own
data from paper into the system’s computers, Amos
and his team had existing data to judge against the
data captured by Captricity. The difference was striking.
“When compared against manually-entered data, the data
extracted with Captricity was much more accurate,” he
notes.
Amos is also pleased with how easy Captricity is to use.
“Whenever I upload my scanned documents the next day
Captricity shreds the data for me. And even online I am
able to view the data points and check whether they are
correctly captured. We are able to edit and then input the
correct data. When a field is blank, you know it’s blank.
And it has been very efficient and very interesting using
Captricity.”
Caprticity’s 99.9%+ accuracy rate is a big asset for Amos,
too. “It helps a lot because normally I am always away
from the office. I’m always in the field,” he explains. “And
what has actually been a help is the quality of the data
being captured as compared to someone sitting behind a
computer inputting it themselves.”
By accurately capturing and transforming handwritten
and typed information into research and business-ready
data, Captricity’s cloud-native platform eliminates the
time, effort and cost of manual data entry. “Big decisions
came when we did the one-year assessment of our Wave 1
facilities and Captricity helped us to make a quick decision
in order to modify our strategy in monitoring,” Amos says.
“I must say it has been very helpful for us using Captricity and very appreciated.”
Amos Asiedu Monitoring, Evaluation and Research Officer for Jhpiego
THE JHPIEGO STORY
Giving organizations faster and easier access to high-quality data to help drive the world forward.
Learn More at Captricity.org
Saving lives is the sweetest success of all
Although research results are still being tabulated as of
this writing, Amos tells us that, based on preliminary data
collected from the Jhpiego project, the fresh stillbirth
rates in Ghana are in decline and the institutional 24-
hour newborn mortality rate is as well. And that’s just the
beginning.
To learn more about Jhpiego’s mission to save
mothers and their children in Ghana and around
the globe, visit
www.jhpiego.org.
SOURCES
(1) http://dhsprogram.com/pubs/pdf/SR224/SR224.pdf
(2) https://www.cia.gov/library/publications/resources/the-world-factbook/geos/gh.html
(3) http://dhsprogram.com/pubs/pdf/SR224/SR224.pdf
(4) http://www.jhpiego.org/content/who-we-are
(5) http://www.ghanaweb.com/GhanaHomePage/health/Project-Fives-Alive-helps-reduce-under-five-mortality-387130
(6) http://www.ihi.org/engage/initiatives/ghana/pages/default.aspx
(7) http://www.gatesfoundation.org/How-We-Work/Quick-Links/Grants-Database#q/k=ghana&page=2