7th February 2013 - Health Links Forum Meeting-Maternal health in Malawi

Health Links Forum Meeting 57th February 2013


2.15pm: Welcome 2.20pm: Joyce Banda video2.25pm: TED Blog

2.40pm: Scotland-Malawi maternal health links Part 13.15pm: Tea and coffee break3.30pm: Scotland-Malawi maternal health links Part 24.00pm: Discussion groups: Addressing the challenges and finding solutions4.45pm Brief plenary4.55pm The way forwards5.00pm Close


http://www.nyasatimes.com/malawi/2013/01/11/joyce-banda-discusses-safe-motherhood-in-malawi/





St Andrews-Malawi Partnership

1st SGIDF-funded project.

• Partnership between the Medical School at St Andrews and the only medical school in Malawi, the College of Medicine.

• St Andrews collaborated with College of Medicine (COM) to assist the College with a major review of the undergraduate medical curriculum.

• The changes were identified and driven by the need to modernize the curriculum content and its delivery, and significantly increase the number of medical students in training.

• As a result of two joint conferences in Blantyre, the COM implemented a new 21st century curriculum in January 2009.

• The COM has now reached the point of admitting 100 medical students per year up from 40-50 before this project started.

2nd SGIDF-funded project.

• We will extend the curriculum review to the Allied Health Sciences programmes in the COM.

• Extend the curriculum review to the Diploma for Clinical Medicine in the COHS in Lilongwe, liaising with other projects pertaining to the clinical training of these students

• Development of an Honours B.Sc. in Biomedical Science at COM to give a new science degree programme

• Working with the library at the COM to improve the efficiency in resource utilisation.

• Encourage the existing partnerships between Malawian undergraduates and those at St Andrews.

2nd SGIDF-Funded Grant

• Work with the Department of Community Health to develop a postgraduate Masters in Global Health at the COM.

• Extend current IT and LT support available to other local degree programmes and out to other campuses.

• The LT team will work with the Malawian systems developers to consolidate and extend the online curriculum management system currently used by the COM to all its programmes.

• Purchase of 50 PCs and monitors for Lilongwe computer classroom. Purchase of desktop PC software licences for each.

8

School of Health,Nursing & Midwifery

The Development of a Multi-Professional

Skills Lab in Blantyre Malawi

N

Dumfries Campus

Ayr Campus

Hamilton Campus

Paisley Campus

Campus Locations

Four Campus Equity

Alison Mc Lachlan 12th December 2006

International Development Projects

• Three year Grant Award Scottish Government (2006-9) 1. Educational development of acute care

skills / transfer of CS technology (IDF SM9)2. Development of a support programme for

newly-qualified practitioners (IDF SM10)3. Consultancy for 4 year BSc in Nursing /

Midwifery (KCN)

Lilongwe – Kamuzu College of Nursing and Malawi College of Health Sciences

Current International Development Project

• Project M53 ‘Development of a multi-professional skills lab at Blantyre Malawi’

• Partners:College of MedicineKamuzu College of NursingMalawi College of Health Sciences

• Methodology: ‘Train the Trainers’ Live Video Link -SMOTS (Scotia Medical Observation & Training System)

BlantyreCollege of Medicine

Multi-Professional Skills Lab

Kamuzu College of Nursing Leadership & Management Programme

Outcomes • Clinical Simulation established-4 Nursing Skills

Labs across Lilongwe, Blantyre and Zomba Regions

• 1 Multi-Professional Skills Lab, Blantyre -establishment of inter-professional education

• Future live video link from Blanytre to Scotland –huge possibilities L & T

• Enhanced curriculum design and clinical simulation embedded in curricula (pre/post graduate/CPD)

Thank you for listening

Zikomo Kwambiri

VSO ScotlandMaternal Health Projects in

Malawi

Aim: Develop a strong, long term volunteering programme that transfers skills between UK and Malawian health professionals, leading to the immediate and long term improvement in quality of maternal health services for poor and rural women in Malawi

THET project: Bringing together midwives and nurses to improve maternal health in Malawi through volunteerism and partnerships

The project will:Recruit volunteer tutors and advisers to contribute to scaling up the number of highly skilled and qualified nurses and midwives in MalawiIncrease recognition of value of international volunteering amongst UK Health professionals, as a valuable part of their medical career – support from RCN, RCM in UK

Volunteers:•21 nurse/midwifery tutors •2 midwives/nurses as CPD facilitators •2 Malawian Diaspora nurses or midwives •6 Organisational Development Advisers working in 7 nurse training institutions: Kamuzu, St John’s, Nkhoma, St Lukes, Trinity, Malamulo, Mulanje

THET activities

and 6 HR/ Management information advisers working in the Ministry of Health to improve the quality of HR Management information systems

Project partner - the Nurses and Midwives Council of Malawi will support the CPD programme

AimTo improve the skills of clinical staff – specifically midwives – to promote maternal services and improve knowledge and health seeking behaviour of communities in Ntcheu (Ganya and Njolomole Traditional authorities)

Ntcheu Integrated Maternal Health Project – Scottish Government funded

The project will:Increase the retention of qualified nurses and midwives providing ‘on the job’ support to the Continuous Professional Development Facilitator and 25 nurse/midwives across 11 health facilitiesSupport Safe Motherhood Groups which raise awareness of maternal health risks and services

Volunteers:Two nurse/midwife volunteers volunteering for 2 yearsTwo Malawian Diaspora volunteers, volunteering for 3 months

Volunteers will provide ‘on the job’ support and structured CPD activities for local nurses and midwives

Ntcheu Integrated Maternal Health Project, 2

Partner agencies:Peri-natal Care project (PNC)within Ministry of Health – will co-ordinate Safe Motherhood groups

Theatre for a Change – will use popular theatre to promote safe motherhood

Parent and Child Health initiative (PACHI) – linked with University College London Centre for International Health & Development – will monitor and evaluate project impact

MIND – Scottish based Malawian diaspora NGO – will recruit Malawian midwives and disseminate info in Scotland

Fiona Forsyth0131 243 [email protected]

Supporting Midwives in Rural AfricaA model for retention in the Malawi CMT programme

Objectives Develop capacity for clinical teaching by providing

training and teaching/learning materials Develop model of mentorship for CMTs Support review and updating of curriculum Increase health systems support for rural midwifery Embed midwives in communities Evaluate the impact of CMT programme

Project scopeAim : to strengthen and evaluate the training and support of midwives in rural Malawi

Retention of midwives in rural areasMentoring and supervisionContinuing professional development/career pathEnvironment of care ReferralProviding acceptable care

Challenges for maternal health

CommunicationsEmploying a project officerAccessing fundsAccessing sitesDemonstrating impact

Challenges for project team


Tea and coffee served at the back of the hall

Scotland Malawi Anaesthesia

Dr Catriona ConnollyFounder:

Ninewells Hospital,Dundee

Malawi lead:Mr Cyril GoddiaAnaesthetic Clinical Officer

With thanks to:• Instructors• SMMDP• ALSG• SSA• SICS• RCOA• OAA• AAGBI• NHS Tayside, NHS Lanarkshire• Colleagues who collect equipment• Medical physics Ninewells• Fundraisers and donors• Avian graphics, Dundee• ASCO shipping, Aberdeen• Senergy Oil, Aberdeen• Malawi CHS

Overview• Link established 2005• Education: 43 courses including 2 train-the-trainers- ACOs from

throughout Malawi• Critical care/ obstetric and paed emergencies and trauma/transport of

critically ill/advanced life support/Communication(SBAR)

• Sustainability: Developed Local faculty

• Equipment- reconditioned “condemned”• Support from ministry- establish HDUs• New project on multi-disciplinary training in obstetric emergencies

Monitoring and Evaluation• Feedback from course participants• Pre- and post- course tests of knowledge• Supervision of local faculty teaching• Data from hospitals following HDU provision

Dedza hospital data

Pre-HDU 2011

Transfers to central Hospital

80% 6%( 9/148)

Maternal deaths per month

3-4 1-2

Balaka Hospital data Pre- HJDU 2011

Maternal deaths per month 3-4 2

Mangochi (8,300 deliveries)-2 HDUs 4 bedded maternity and 2-bedded general HDU

2006 2011

HDU admissions per annum

0 300

sepsisabortioneclampsia

2745048

530 -i.e. x19 650- i.e. x1.4 112 – i.e. x2.3

Referrals to ZombaCentral Hospital

30% of previous years

In-hospital annual maternal mortality 120 60

Effect of Scotland Malawi Anaesthesia courses

Pre- 2006• No critical care at district

hospitals• Many deaths during transfer of

unaccompanied critically ill to central hospitals

• Poor communication from referring hospital

Post course• Critical care provided in

district-Transfer numbers decreased by up to 74%

• Of those treated locally- survival rate is 70-80%

• Transfers are conducted safely- proper resus, personnel and communication

Maternal deaths decreased by 50% in the 3 centres collecting data

Current Challenges

In Malawi1. Essential equipment and drugs2. Per Diems3. Taxes on equipment entering the country

In Scotland: Administration of grants- NHS act is interpreted as prohibiting accounts dept from administering grant unless the project is of direct benefit to the people of Scotland Leave from NHS departments to deliver teaching.

Aspirations for SMP support

With Malawi government:1. Encourage discussion on per-diems at Malawi ministry of Health –

including all NGOs2. Negotiate on taxes applicable on donations entering the country

With Scottish Government:3. Discuss Scottish Government commitment through the NHS- specifically- Effect on Scottish waiting lists of additional leave by hospital doctors. Should we include locum and “on-costs” in our grant applications 4. Discuss Scottish Government position on Scottish NHS accounts

departments administering grants.

Malawi Maternal Health Meeting

Dina McLellan7th February 2013

May 2005 – Scottish Franchise ALSO UK (self financed)

November 2005 – Scotland signed co-operation agreement with Malawi:

Contribute to the improvement of maternal health by supporting the increase in the number of trained midwives and facilitating the exchange of knowledge and skills required for dealing with obstetric and gynaecological emergencies

Scottish Government Funded Malawi Maternity Emergency Skills Training -ALSO®

Dr Hetherwick NtabaMinister of Health, Nov 2005

3 year funding 2005/2008 Extended 2009/2010

Sorenson, B L., Advanced Life Support in Obstetrics (ALSO) and post- partum

haemorrhage: a prospective intervention study in Tanzania., Acta Obstetricia et

Gynecologica Scandinavica, Volume 90, Issue 6, Page 609-614, June 2011

Adaptable Incorporated local needs Development of one day course BLSO

Maternity Emergency Skills Training -ALSO®

Maternity Emergency Skills Training -ALSO®

1238 - 2 day ALSO

151 – one day emergency skills training / BLSO

>40 instructors

ALSO Malawi – Advisory Faculty

BEmOC

Build on past success Utilise extensive instructor resource Avoid duplication of effort / conflict Ongoing co-operation and communication

between MOH/RHU

Future ?

Maternal health research at IIHD

Source pictures: GuardianUK, UNICEF

Dr. B de Kok [email protected]

mailto:[email protected]

IIHD Maternal Health ProjectsProject 1. Loss in childbearing in Malawi: How interpretations of responsibility, blame and entitlement to care may affect maternal health care.

Dr. B. de Kok, 1 year research project. Funder: ISRF

Project 2. The changing role of Traditional Birth Attendants in maternal health in Malawi : An exploration of stakeholders’ perceptions

Isa Uny, 3 year doctoral research project

• Both qualitative studies, both just started.

Partnerships for maternal health

• Malawian partners: – Centre for Social Research, Zomba.– KCN (Address Malata)– clinical officer, community member– Challenges –unknown; too early !

• SMP:– Learning, avoiding duplication– Universities; critical reflection, deeper analysis of

‘nebulous’ aspects

Screening for diabetes in pregnant women in Malawi

A simple way to improve maternal and neo-natal health

What is gestational diabetes?

Gestational diabetes.

• Diabetes mellitus which is detected for the first time during pregnancy.

• May be undiagnosed diabetes. • May be diabetes that develops during

pregnancy and then ‘disappears’ shortly after the birth of the baby. In Scotland, mother is tested 6 weeks after delivery.

Gestational Diabetes.

• If diabetes in the mother does ‘disappear’ after the birth of the baby it is likely to be present in future pregnancies and the mother has an increased risk of developing diabetes later in life.

• *Women with a history of GDM have a 60% chance of developing diabetes (usually type 2) within the subsequent 20 years and this risk is increased by obesity. For this reason they should --- have an annual fasting glucose measurement performed.

* NHS GGC Guidelines

Diabetes.

• Pregnancy causes changes in glucose levels in the mother.

• Increasing glucose levels in the mother increases supply to the fetus hence enhanced growth of the fetus.

• Gestational diabetes may develop – if not controlled, mother and offspring at risk.

• Type 1 and Type 2 mothers and their offspring are at similar risk if diabetes uncontrolled.

Risks to the fetus:

• Developmental malformations• Increased insulin secretion• Accelerated growth

Risks to the neonate:

• Reduced glucose levels in the blood of the neonate

• Impaired production of lung surfactant – increases risk of respiratory distress syndrome

Risks to mother:

• Miscarriage• Pre-eclampsia• Premature labour• Polyhydramnios

What should be done.

• Pregnant women with diabetes should be offered dietary advice and blood glucose monitoring.

• They should be treated with glucose lowering therapy

(Sign 116)

Anecdotal evidence.

• Information from three former students of GCU who are DSNs and have visited Malawi.

• Women and their offspring are dying or suffering needlessly because gestational and other types of diabetes are not detected.

What we want to do.

• Produce and distribute posters to raise awareness of diabetes.

• Send a small team of experts to Malawi (pharmacist, physiologist, nutritionist, midwife and diabetes nurse specialist) to train and educate health workers on the problems caused by diabetes.

• Note: we are in contact with (and have the support of) a medic who is in Malawi and is a diabetes expert.

What do we want to do? (continued)

• Bring a number of interested health workers from Malawi to GCU so they can attend postgraduate education in diabetes care and management and attend relevant clinics in Scotland.

• In due course these health workers can educate and train other health workers in Malawi.

What can you do?

• Please contact Jane Nally ([email protected]) if you are able to help in gathering evidence or offer experience that can help us to apply for funding for this initiative.


www.waverleycare.org

SMP Health Links Forum

Tamara Mhura

St Augustine Church

07th February, 2013


Who we are

Voluntary organisation

Delivering prevention, care & support services across Scotland for people living with HIV and Hepatitis C

Includes an African Health Project90

Raise awareness

Encourage behavioural change

Improve access to health services

Deliver campaigns & Study circles

Deliver maternal health programmes


What we do in Malawi

91

Maternal Health

Early attendance at antenatal clinics

Urge husbands to accompany wives

HIV testing

Family planning

PMTCT

www.waverleycare.org 92

Success stories

EHAPs PMTCT statistics

More husbands attending clinics with their wives

Study Circles & peer education


Challenges

Only 56% of women in MLW give birth at health clinics; reduces to 50% in Mzimba

Mzimba has few clinics which are scattered & hard to reach

Unfriendly/ unsympathetic health professionals

Lack of facilities for guardians

Harmful cultural beliefs/practices


Lament of a husband whose wife and baby son died in childbirth

When I see a nurse

“Me, when I see a nurse, I see cruelty. When I see a nurse I see a witch,


Contact me:

Tamara Mhura, Waverley Care

[email protected]



Input from MaSP Health Group Members

Ms Grace Goti Tahuna Soko, Deputy College Principal, Holy Family College of NursingDr Alexander Chijuwa, District Health Officer, Phalombe District Health OfficeMr Steve Musopole, Principal Architect, Malawi PolytechnicDr Mulina NyirendaAdult Emergency and Trauma Centre, Queen Elizabeth Central Hospital,

(Ninewells Hospital), Mr Fyneck Kufeani, Electrical Engineer, Malawi Polytechnic, (UWS)Mr Webster Kadazi ChitsuloSecretary, Kuthandiza Osayenda Disability Outreach, (Global Concerns

Trust)

Contributing factors to improved maternal health in Malawi

• Waiting antenatal wards, and an increase in number of rural maternal clinics

• Community-based health: HSAs, community leaders, etc

• Training of community midwives• Safe Motherhood Initiative• Up-skilling technicians where no registered

nurse or midwife available• Training of traditional birth attendants

Main challenges towards improving MH in Malawi

• Lack of resources: skilled personel, equipment, medication and finances

• Inadequate infrastructure: access, facilities (electricity) and space

• Socio-cultural attitudes: limited community participation, family planning

• Information transfer and illiteracy

A Scottish contribution?

• Infrastructure: building district hospitals, maternity units, training centres

• Equipment: ambulances• Education: campaigns in schools

and in the community• Training: training and retaining

health professionals

Summary of recommendations from 2011 SMP Report:Malawi-led: Projects have to be developed in response to requests from Malawi. Teaching programmes should be adaptable to different cadres – doctors, nurses, midwives and clinical officers – and should support policies which foster good working relationships between the different professional categories.

Good stewardship: Making sure that funds are correctly used and accounted for.

Sustainable: Training trainers is essential and ensuring local ownership of the programme. If equipment is available for sending make sure there is a need for it and that it can be serviced locally.

Coordinated: Good collaboration between groups in Scotland is important to avoid replication of effort but it is also important to establish that there is not duplication or overlap in Malawi.

Capacity-building in Malawi: In addition to the benefit in terms of trainees working in their own country or region partnerships need to ensure that clinical experience gained was locally relevant.

Exit strategy: Writing yourselves out of the script!

Manage expectations: There is a need to clarify the commitment of Scottish staff going to Malawi on medium-term assignments (anxiety about losing out on National Insurance and superannuation payments).

Health Links Forum Action Points

• MOU with NHS• NHS administration of funding

• Enabling Malawi-led ideas: working with MaSP to coordinate

efforts from Malawi• SMP training on financial

management (Q3/Q4)• Discussion among SMP members

on impact of devaluation on partner projects in Malawi

• Important of education/relationship to

maternal health• Coordination with other SMP

forums and other organisations• Further discuss on challenge of per

diem culture (SMP event?)• Promoting inter-disciplinary

approaches• Supporting leadership

management initiatives in Malawi• Up-skilling

7th February 2013 - Health Links Forum Meeting-Maternal health in Malawi

Health & Medicine

Transcript of 7th February 2013 - Health Links Forum Meeting-Maternal health in Malawi