Presenter: Georgina Msemo, Department of Family and Reproductive Health/International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health
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Background: In Tanzania, addressing birth asphyxia, a leading cause of newborn death, is a national priority and includes scale up of Helping Babies Breathe (HBB).
Methodology: HBB scale up – led and coordinated by the government with high-level commitment, ownership, stakeholder consensus, a country scale-up plan and technical and financial support focuses on preparing competent providers, improving facility readiness and strengthening the routine health information system (HIS).
Results: Over 17,000 providers were trained and more than 3,300 health facilities across 16 regions were equipped with resuscitation devices, training manikins and job aids for low-dose high-frequency on-site trainings. After 1 year of implementation, the number of deliveries conducted by an HBB-trained providers increased from 0% to 58%. However, lack of on-the-job support, continued practice after training and rotation of trained staff out of labor wards hampered retention of skills and programme impact. To address these challenges, the Government of Tanzania implemented a set of course correction activities including refinement of the HBB training curriculum, development of an on-the-job training and set up of SMS learning reminders system to maintain skills. Newborn resuscitation competencies were also included in the pre-service curriculum. The routine HIS was updated to include key HBB steps and the number of newborns resuscitated. As a result of these interventions, the proportion of deliveries attended by an HBB-trained provider increased to 82% by 2015.
Conclusions: Health systems strengthening is essential for successful scale up and should include support for logistics, routine HIS strengthening and policies for continuous professional development to retain and update clinical skills. A key next step in Tanzania is implementation of a clinical mentorship system and ongoing strengthening of the HIS to improve measurement of newborn health service delivery and outcomes.