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

The Challenge

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.

Overview

URC supported the Guyanese Ministry of Public Health (MoPH) to design and implement interventions to strengthen reproductive, maternal, neonatal, and child health (RMNCH). The Support to Improve Maternal and Child Health (SIMCH) Project was 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 project worked to strengthen all levels of the health system (community, health facility, regional, and national) and improve the quality of services across three targeted regions (Regions 3, 4, and 9).

URC supported the MoPH Maternal and Child Health Unit by developing and supporting implementation of a national quality of care strategy, designing an integrated health benefit package (HBP), developing a community health platform to increase timely access to and use of RMNCH services, and building clinical and improvement capacity at community, facility, regional, and national levels to sustainably reduce maternal and infant mortality in Guyana.

• 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 focus areas:

1. Develop tools 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
2. Strengthen community health committees and empowering communities to improve utilization of RMNCH services for hard-to-reach populations
3. Create and strengthen existing national, regional, and facility-level structures to improve quality of antenatal, childbirth, and postnatal care across the service delivery continuum
4. Implement 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 RMNCH services:

• Conducted a gap analysis to rapidly assess the capacity of the Guyanese health system to implement quality of care interventions in RMNCH and family planning (FP). The analysis had three objectives: map RMNCH and FP service delivery 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 the target regions.
• Developed training materials based on the new version of the Family Health Manual. URC conducted two trainings in each of the three targeted regions, reaching over 100 health workers.
• Developed coaching and mentoring capacity of national and regional quality improvement (QI) teams by co-facilitating and co-implementing activities and learning-by-doing in select health facilities
• Built a data system for routine tracking of the quality of RMNCH care processes, key inputs, and outcomes.

Community Health Committees (CHC) increased access and use of maternal and child health services in Region 9:

• Formed seven CHCs, covering 11 villages in Region 9 each with 10-15 community members from each village to support community level demand generation of health services at facilities. URC trained a total of 107 people on how to mobilize community members to access health services and how to mobilize community-level resources to overcome the barriers faced by pregnant women and young children in accessing care.
• Local authorities recognized the legitimacy of the CHCs. The committees achieved, and in some instances, surpassed their goals (i.e., adapting their activities to local context needs, such as malaria outbreaks).
• Conducted training in two additional communities as part of the “scale-up” support provided to the Regional Health Department (RHD) for developing CHCs across the region. For sustainability purposes, URC trained two regional-based health workers in the CHC methodology and provided on-the-job training during the coaching visits. URC also provided strategic and operational support to the Region 9’s RHD to scale up the CHC model in other villages.

Continuous QI system designed and implemented at national level and in the three targeted regions:

• Built the foundation of RMNCH Quality of Care structures and processes for strengthening QI capacities in the Guyanese health care system.
• Developed the National Quality of Care Strategy through a consultative process with key decision-makers, including implementation plans for improving the quality of RMNCH care at the facility, regional, and national levels. This included defining the necessary actions and functions that need to be carried out across the health system to achieve the National Quality of Care objectives, which are aligned with broader national quality efforts.
• Increased the capacities of facility, regional, and national QI teams to perform vital QI functions, including organizing continuous QI activities, developing support systems (i.e., supporting coaching, clinical mentoring, and data systems), and creating a learning platform to operationalize the National Quality of Care Strategy for RMNCH.
• Built QI capacity of 64 care providers and regional health management teams
• Built QI and coaching capacity of 32 MoPH staff and partners at the national level
• Developed and supported implementation of various tools for routine data collection, analysis, and use of RMNCH 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.
• With the national QI team, developed and field tested a new birth delivery registry and postnatal care form

Strengthened clinical competencies of health professionals in selected health facilities:

• Developed draft versions of clinical training materials on antenatal, intrapartum, and postnatal care for MoPH review and approval.