Technical Assistance to Support the Design and Implementation of Interventions to Strengthen Reproductive, Maternal, and Neonatal Health in Guyana

Overview

Over the past two decades, Guyana’s health sector has made significant strides, with life expectancy increasing from 62 to 67 years since 1991, and Millennium Development Goal targets being met for nutrition, child health, and communicable diseases. Despite these achievements, Guyana continues to experience maternal and infant mortality rates that are amongst the highest in Latin America and the Caribbean. It is estimated in Guyana that 169 per 100,000 women die giving birth, while the infant mortality rate is estimated to be 26 per 1,000 (WHO, 2017), compared to the regional average of 14.9.

URC provides technical assistance the Guyanese Ministry of Public Health (MoPH) to support the design and implementation of interventions to strengthen reproductive, maternal, and neonatal health (RMNH). The agreement is part of an $8 million loan from the Inter-American Development Bank to help reduce maternal, perinatal, and neonatal deaths in Guyana.

The 24-month pilot program is designed to strengthen all levels of the health system: community, health facility, regional, and national, and improve the quality of RMNH in three targeted regions. URC supports the MoPH Maternal and Child Health Unit by developing and supporting implementation of a national quality of care strategy, an integrated health benefit package, a community health platform to increase timely access and use of reproductive, maternal, and neonatal care, and building clinical and improvement capacity at community, facility, regional, and national levels to sustainably reduce maternal and infant mortality in Guyana.

 

The Challenge

Guyana faces a number of challenges to strengthening its health system including poor health service delivery infrastructure and transportation, shortage of qualified human resources for health, and a fragmented health management information system with limited accountability mechanisms and data use for evidence-based decisions. The country also has disparities in access to adequate medical care. Regions 3 and 4 have large populations with easier access to health care compared to the population in Region 9. Region 9’s poor infrastructure and rough geography makes it hard for those seeking care to access care, contributing to an increased probability of maternal, infant, and child mortality. The isolated nature of Region 9 communities exacerbates making linkages between various levels of care.

 

Objectives

  • Provide technical assistance to design and support the implementation of interventions aimed at strengthening reproductive, maternal, neonatal, and child health
  • Support and facilitate capacity building in the MoPH, regional, health facility, and community structures to improve the quality of RMNCH care and timely access to and use of RMNCH service

Technical assistance focuses on:

  1. Developing tools and mechanisms at the national level to support implementation of the health benefit package (HBP) for women of reproductive age, adolescents, pregnant, postnatal women, neonates, and children to deliver quality RMNCH services.
  2. Strengthening community health committees and empowering communities to improve utilization of RMNCH services for hard-to-reach populations; strengthening community systems and linkages to integrated RMNCH care across community and health service delivery levels.
  3. Creating and strengthening existing national, regional, and facility-level structures to improve quality of antenatal, childbirth, and postnatal care across the service delivery continuum. URC’s team is developing the coaching and mentoring capacity of national and regional QI teams by co-facilitating and co-implementing activities and learning-by-doing in select health facilities. The national/regional QI team then is scaling up the coaching in other health facilities. In parallel, URC is helping to build a data system for routine tracking of the quality of RMN care processes, key inputs, and outcomes.
  4. Implementation of the HBP through building local clinical capacity to deliver quality antenatal care (ANC), childbirth, and postnatal care (PNC) and post-partum family planning (PPFP) services.

 

Achievements

Implementation of a revised integrated Family Health Manual and operational model for RMNH services.

  • A gap analysis was conducted to rapidly assess the capacity of the Guyanese health system to implement quality of care interventions in the area of reproductive, maternal, neonatal, and child health (RMNCH) and family planning (FP). The analysis had three objectives: map the delivery of RMNCH and FP services by facility and care provider type; assess quality improvement (QI) systems and structures; and evaluate critical processes related to RMNCH quality of care and support systems, at all levels of the health service delivery system in 16 health facilities in regions 3, 4, and 9.
  • Training materials were developed based on the new version of the Family Health Manual. Two trainings were conducted in each of the three targeted regions, reaching 70 health workers.

Community Health Committees to increase access and use of maternal and child health services in Region 9.

  • Due to the remoteness of communities/villages in Region 9, access to services at health facilities for care and health education is limited. There is also a limited number of trained community health workers, many of whom are expected to manage the health facility and provide services to the community members on their own. To overcome this challenge, seven Community Health Committees (CHC) were created in Region 9, covering 11 villages which include 10-15 community members from each village (a total of 107 people trained) to assist in informing the community about health services available to them at the health facility and how to access the services and to mobilize community level resources to overcome the barriers that pregnant women and young children face in accessing services.
  • Reporting and supervision system established in Region 9 for monitoring and supporting the CHC activities on a monthly basis.
  • Strategic and operational support was provided to the Regional Health Department of Region 9 to scale up the CHC model in other villages.

Continuous Quality Improvement System designed and implemented at national level and in the three targeted regions.

  • Developed National Quality of Care Strategy and implementation plan at national, regional, and facility levels.
  • Supported capacity strengthening of QI structures at all levels of the health system.
  • Built QI capacity of 64 care providers and regional health management teams in three selected regions.
  • Built QI and coaching capacity of 32 MoPH staff and partners at the national level. The national QI team is now scaling up coaching, improvement, and clinical capacity building with support from the URC team.
  • Developed and supported implementation of various tools for routine data collection, analysis, and use of RMNH quality of care indicators.
  • Developed and supported implementation of over 10 provider decision support tools and job aids for health centers and hospitals to improve quality of ANC, PNC, childbirth, and PPFP services.
  • Together with national QI team, developed and field tested a new birth delivery registry and postnatal care form, to be institutionalized and scaled up nationwide.

Strengthen clinical competencies of health professionals in selected health facilities.

  • Developed draft version of clinical training materials on ante-intra and PNC for MoPH review and approval.

 

QI teams make and discuss run charts showing progress in reducing newborn hypothermia through increased practice of skin-to-skin contact.
QI teams make and discuss run charts showing progress in reducing newborn hypothermia through increased practice of skin-to-skin contact.
Duration
2018 to 2020
Funders 
Inter-American Development Bank
Guyana Ministry of Public Health
Regions/ Countries