The Zimbabwe Electronic Maternal and Perinatal Death Notification System (empdns)

Transcription

1 The Zimbabwe Electronic Maternal and Perinatal Death Notification System (empdns) Fortunate Machingura, Gibson Mhlanga, Henry Chidawanyika, Edwin Mpeta + many others

2 Current levels of fertility & mortality indicate 1 in every 37 women will die from pregnancy or childbearing (ZDHS -2015) MMR - key indicator for health & reflects health system performance & other characteristics such as intersectoral collaboration, transparency and disparities. Lifetime risk of maternal death: Current levels of fertility and mortality indicate that 1 in 37 women will die from pregnancy or childbearing MMR is estimated at 651 deaths per 100,000 live births In other words, between , for every 1,000 live births in Zimbabwe, slightly more than 6 women died during pregnancy, during childbirth, or within 2 months after childbirth.

3 Zimbabwe MMR Trends

4 Institutional delivery and family planning usage rates are high The paradox for Zimbabwe is that institutional delivery and family planning usage rates are high Contraceptive prevalence rate is 67% Between 2010 and 2015 about 77% of live births were delivered in a health facility, while 20% were delivered at home Unskilled persons, such as TBAs, VHWs and relatives/friends, assist in 20%, while 3% of births receive no assistance

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6 The disconnect between key indicators points to poor quality of care. HIGH INSTITUTIONAL DELIVERY AND FAMILY PLANNING USAGE RATES BUT, MMR STILL TOO HIGH. The leading causes of maternal death are largely preventable Classification of the causes of death using the 3 delays model show that the 1 st, 2 nd & the 3 rd delays significantly contribute the preventable maternal deaths

7 leading causes of maternal death are largely preventable. Causes of maternal deaths, [Zimbabwe DHIS2, 2016] Post-Partum Haemorrhage 19% Puerperal sepsis 13% AIDS defining conditions 12% other 11% Eclampsia 10% Post Abortal Sepsis 7% Pregnancy Induced Hypertension 5% Cardiac Disease 5% Ruptured Uterus 5%

8 Problems in accessing Health Care Almost 2/3rds of women (49%) report at least one of the problems associated with accessing health care for themselves (ZDHS 2015) getting money for advice or treatment - 43% distance to a health facility -33% not wanting to go alone -14% getting permission to go to the doctor -5%

9 The empdns The MoHCC has embarked on strengthening quality of care in maternal health. MDSR - the Electronic Maternal and Perinatal Death Notification System (empdns) objective of the empdns a) to assist in improving the data storage, quality, transmission, retrieval and use of maternal and perinatal deaths data. b) provides opportunities to understand the underlying causes and factors leading to maternal deaths c) recommend actions that will prevent future deaths. d) The empdns builds on already existing programs for MDR where each maternal death is reviewed by a local MDRC to examine the factors contributing to the maternal death.

10 Development of the empdns The empdns works alongside the existing DHIS 2 platform which is being used in the country for HMIS data collection and management systems. paper death notification forms and data reviews.

11 DHIS2 Welcome screen

12 PILOT OVERVIEW PROCESS 1.0 Pilot preparations -June-September 2016 Select Sites (MoHCC) suggest 2 provinces. 1 provincial hospital, 1 district hospital, 1 other hospital, 1 central hospital per province Gathering user requirements and specifications select participants for training (MoHCC) identify, inform participants and ensure readiness for the pilot (include provincial and district management) provide pilot equipment and materials - ICT equipment - Tablets, Sim cards, Credit top-up (UNFPA) Developing database and user guide for the pilot training (RTI Intl) provide and use existing MPDN forms for the pilot for training (RTI Intl) 2.0 System administrator training - September to November 2015 train system administrators 1/2 training to prepare NHIO/NHICTOs to setup tablets for piloting train NHIO/ICTO to set-up empdns equipment, administer empdns & the functionality of the system at plot sites one-week training in Manicaland province (20 Hosp); Masvingo province (13 Hosp), Harare Central and United Bulawayo Hospital (16 districts) over 150 health workers trained included all managers (DMOs, DNOs, SIC, HIO) each facility received at least one data enabled tablet for data capturing

13 PILOT OVERVIEW PROCESS Cont 3.0 Pilot Monitoring, Support, supervision and mentoring conduct supportive supervision visits (MoHCC/UNFPA/RTI Intl) establish a help desk: Set up Phone in and help desk systems to support users (RTI Intl) 4.0 Pilot review Review the pilot hold a workshop and follow up through in-depth interviews and FGDs: people who interacted with the system including health workers and other players e.g. the VHWs ((MOHCC /RTI Intl) Use the review findings to inform the next steps - improve the system based on lessons learnt and possibly roll out to other provinces, update the empdns and its user manuals (MoHCC /RTI Intl)

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15 Overview of system

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17 Dashboard 17

18 Available Applications

19 An assessment of the empdns showed impressive improvements Functionality: data available at all levels as soon as it was captured. data reviewed and comments shared online at district and provincial levels. reports generated for the required time periods for specific geographical areas reports created and shared. data easily stored and accessed by users. data could be downloaded and analysed using other statistical packages

20 But, there are some challenges Poor computer skills limiting efficient use of the system. Challenges with internet connectivity in some areas Of the visited facilities, only 37% had a formal MDRCs although all facilities reported regular reviews of maternal deaths Only 33% of the facilities reported including community health workers as part of the committee More than half (64%) were not conducting verbal autopsies For those that conducted VA, no standard tools were used

21 But, there are some challenges 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% challenges in MDRs reported by health workers complete Attitude, or missing some case feel notes it is Doctors a fault not finding available community process for audits deaths staff not shortage reportedand wor

22 But, there are some challenges VHW are responsible for notifying maternal death in the community But of the interviewed only 31% were able to give the correct definition of maternal death The majority of VHWs, were not aware of the existence of a MDRC at the health facility that discusses and reviews both institutional and community deaths Challenges cited by VHWs on reporting maternal deaths were: Failure to access information on maternal deaths from the community Lack of training on maternal death reporting and notification Lack of resources and standard tools to use in reporting Delays in reporting as they have to physically report the death at the health facility

23 Lessons learned Development of the system: 1) Allocate adequate time for system and software development 2) Stakeholder consultation critical for buy in and acceptance of system - MDSR steering committee. 3) Allocate adequate time to train users on how to run and maintain the system 4) Need to have a community tool for capturing community deaths

24 Strengthening MDSR.. Next steps Introduce a community linked approach to MDSR, (Community Health management information system) one that can harness the motivation of the community to prevent MDs, improve and review deaths. Improve quality of MDR meetings, providing opportunities for education of maternal health and, stimulation across communities and health facilities Strengthen completeness and timeliness of reporting MDs

25 Woman dies Notification by VHW to the Health facility using the Empdns. Basic Info on the woman s death collected and an initial consent for a verbal autopsy sought Verbal Autopsy conducted by a trained HW. Standard tool used. Structured Interview with relatives on the events leading to death Community CLMDR meeting. Factors contributing to the death and action plan to prevent future deaths explored Health Facility CLMDR. Discuss death and Action plan to prevent future deaths Community Feedback meeting facilitated by the HCC, CST and HWs

26 Leaving-no-one behind sustainable health systems