Researchers from the Navrongo Health Research Centre (NHRC) have recommended the replication of promising social and behavioural change strategies for promoting exclusive breastfeeding, which, were tried in the Upper East Region (UER) of Ghana.
The Researchers who presented the findings and lessons learnt from a baseline assessment of the two-year Quality Improvement (QI) model Mother-Baby Friendly Health Initiative (MBFHI) project, implemented in the UER by UNICEF, to stakeholders in Accra, said implementing the WHO standards for breastfeeding in low and middle income countries was feasible, however, good leadership was key to its success and sustainability
They, therefore, recommended that the Ghana Health Service (GHS) should develop an integrated and consolidated unified Mother, Newborn and Child Health (MNCH) Quality Improvement (QI) model for the country that could, be used by all agencies, and further called for leadership to ensure the integration of the Every Mother Every Newborn (EMEN) QI model into all in-service training programmes.
They also urged UNICEF to facilitate a stakeholder workshop at the district, regional and national levels to disseminate the key findings and consider the way forward, while the GHS ensured the sustainability of the clinical mentorship component of the EMEN QI, which effectively enabled lower level staff to learn intermediate skills from specialists.
The Director of the Navrongo Health Research Centre, Dr Abraham Oduro, said improvements were being reported in early attendance of antenatal care, facility-based deliveries, uptake of UNICEF and GHS recommended breastfeeding practices, male involvement as well as perinatal mortality and neonatal case fatality rates in the intervention communities.
The Head of the Research Team, Dr John Williams said the study engaged over 300 communities in the Bawku and Bolgatanga Municipalities respectively, as well as Bongo and Kassena Nanakana West Districts, through three selected hospitals, 21 health centres and 82 CHPS facilities, and took the form of a baseline assessment before the implementation of the interventions, monitoring and a final progress assessment, after the successful completion of the project in 2018.
The focus included an assessment of whether mothers and newborns were receiving essential care around the time of birth, and infants were fed exclusively with breastmilk, without being given water, other liquids or foods for the first six months of life, he said.
Francis Yeji, a Researcher, NHRC, said the findings revealed among other things, a general increase in knowledge, improvement in exclusive breastfeeding practices, as well as improved infrastructure and Water, Sanitation and Hygiene (WASH) services especially in labour wards, leading to better maternal and newborn health outcomes in the experimental facilities.
There was also an overall decrease in the case fatality rate in newborn resulting from increases in facility assisted deliveries, compared to what pertained before the implementation of the project, while the introduction of clinical mentoring proved effective as it allowed skilled staff to directly mentor and train lower facility level staff in intermediate skills.
He said some of the lessons learnt included the fact that communication such as weekly calls, social media, monthly QI meetings between implementers were key, while availability of functional essential equipment, drugs and supplies at health facilities were vital ingredients to model‘s effectiveness.
Mr Yeji noted that quality of care could be the entry point for wider health systems improvement in the intervention facilities, since they ensured less drug stock-outs, improved documentation of good practices and outcomes and improved quality and use of data to inform changes.
He also stated that community engagement was pivotal to success, as community members felt “health workers attitudes changed and were more welcoming to them,” because Fundamental Human Rights were observed and the experience of care was dignified and respectful in intervention facilities compared to the others outside the project.
Dr Kofi Issah, the Director for Family Health, GHS, urged the Researchers and UNICEF not to leave the report hanging, but to identify, champions within the GHS to sell the idea to other districts, and also called for a simple implementation plan which was easy to follow.