Joint Monitoring Visit by Ministry of Social Development and Golden Community in Lumbini Provincial Hospital on SUSTAIN

Joint Monitoring Visit

by Ministry of Social Development, Lumbini Province, Butwal
Golden Community
in Lumbini Provincial Hospital, Butwal on
Scaling up Safer Birth Bundle Through Quality Improvement in Nepal

A joint monitoring visit led by Health Service Division of Ministry of Social Development (MoSD), Lumbini Province, Butwal was conducted on 14-17 th October, 2020 in Lumbini Provincial Hospital, Butwal with the objective to monitor the status of SUSTAIN (Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal) project and to identify potential gaps in implementation of safer birth bundle. Technical staff of Golden Community was present during the monitoring field visit and discussion. A semi-structured tool developed by Golden Community was used to facilitate the discussion. The discussion session was led by Chief of Health Service Division. After the discussion, information on the availability, relevance, and effectiveness of safer birth bundles was gathered using a similar semi-structured tool with assistance from Hospital Nursing Inspector and Nursing Officer.

Photo 1: A group discussion on status of SUSTAIN led by Dr. Uma Kant Chaudhary, Chief of Health Service
Division, Ministry of Social Development, Lumbini Province, Butwal with hospital staffs (Dr. Bhakta B. Raut, Dr.
Netra Rana, Ms. Jyoti Paudel and Ms. Putala Khanal) at Lumbini Provincial Hospital, Butwal.

The major highlights of the discussion were:

Dr. Netra Rana shared “We were trying out best from quite a long time to increase the rate of delayed cord clamping. Though we have not reached 100%, considerable improvement had been observed. Early breastfeeding, early skin-to-skin contact, handwashing has also improved. Early intervention following the use of Moyo is also one of the positive sides seen after implementation of SUSTAIN. ”and also mentioned that “Everyone now has become sensitized about the importance of bag & mask in the labour ward. The training program had brought a positive impact towards the attitude of health workers… Moyo provided a positive phycological effect among the patient party, mothers and health workers, thus making it easier to work and make early intervention than before… Besides, we have become skillful and quality of care has increased.” He said that “I received the training in two batches and found it very effective. SUSTAIN has been well implemented at this hospital though COVID situation disturbed its pace for a while.”
Dr. Bhakta B. Raut shared “SUSTAIN interventions such as Moyo is very effective for monitoring. For example, a smaller number of staffs can even monitor large number of mothers in active stage of labour. The alarm system of Moyo makes it more useful during busy hours. At the time of COVID, Moyo has proved that intrapartum monitoring can be done by maintaining social distancing measures which ultimately helps in reduction of contamination and transmission of infections and diseases. So, I think this is scientifically good.”
Accordingly, Ms. Jyoti Paudel mentioned that “Through SUSTAIN project, technologies like Moyo and NeoBeat which are very important to improve the quality of care at intrapartum period.” And also shared “SUSTAIN interventions are time and often monitored and followed-up to know what is lacking and to make necessary corrections through PDSA meetings. Besides, SUSTAIN has enhanced the skills of the staffs and strong feedback system is also one of the strengths of SUSTAIN project. The major changes I’ve observed is the attitude of staffs towards providing care to the mothers and newborns.”
Ms. Putala Khanal shared that “Mothers have become more supportive as they are ensured that they are being monitored and ask for Moyo… Staffs are also happy because Moyo has helped in decision-making and making early interventions.” She also mentioned that “The staffs provided help us to record the time of delivery, inform whether golden one minute was achieved or not, encourage early and exclusive breastfeeding, skin-to-skin contact and sometimes with the delivery when human resource is inadequate at the labour ward.” And also shared that PDSA meeting is among the most effective interventions as it provides a chance for the staffs to identify problems, discuss the way out and act for improvement.

Photo 2: Dr. Uma Shankar Pd. Chaudhary and Mr. Ankit Acharya at MoSD, Lumbini Province

Ms. Jyoti and Ms. Putala shared that Safer Birth Bundle has helped in improving the quality of intrapartum care at labour ward. They agreed that Moyo, NeoBeat, Upright bag-and-mask was rated as very effective and better intervention than the previously used horizontal bag-and-mask. They shared that it was more convenient to use as it provided a better seal and gave a clear chest rise and also shared that Moyo was rated as very effective intervention as it was very helpful for FHS monitoring. It produces clear sound, indicates fetal distress caused by meconium staining and also provides psychological support to the mothers. NeoBeat was also rated as very effective intervention as it guides staffs for further resuscitation procedures. Because it displays heart rate for non-breathing babies, it indicates.