Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN)

Golden community in collaboration with the Ministry of health and Population, Government of Nepal (GoN) and Uppsala University has scaled up a set of quality improvement interventions specific to improving intrapartum care aimed atreducing intrapartum related mortality (intrapartum stillbirth and neonatal death within first 24 hours of life) in Nepal.

SUSTAIN has been implemented in different public hospitals of Nepal: Koshi Hospital, Janakpur Hospital; Bharatpur Hospital; Lumbini Provincial Hospital; Bheri Hospital; Province hospital, Karnali; Seti Provincial Hospital and Dadeldhura Hospital. The programme is financially supported by Grand Challenges Canada, Canada and commodity grant supported by Laerdal Global Health, Norway for a period of two years from April,2019.

Figure: Design framework of SUSTAIN Package


SUSTAIN package includes

  • Set of quality interventions

    • Orientation of SUSTAIN and its components to concerned stakeholders

    • Bottleneck analysis around maternal and newborn care services

    • Plan Do Study Act meetings to solve the problems related to newborn and maternal services within the department

    • Progress boards with major newborn indicators

    • Daily Skill checks using advanced neonatalie (to maintain ventilation skills of health workers with Low Dose High Frequency approach)

    • Helping Babies Survive Training in partnership with National Health Training Center and Nepal Paediatric Society: A four-day training around the care of newborn. There are four components: Helping Babies Breathe,second edition; essential care for every newborn; essential care for small babies; PDSA model/meeting

    • Mentoring and Review meetings with stakeholders at provincial and central level.

  • Safer Birth Bundle

    • Moyo foetal heart rate monitor (shows real-time heart rate of foetus)

    • NeoBeat newborn heart rate meter (shows real-time heart rate of newborns at birth)

    • Advanced Neonatalie (automated feedback providing manikin during ventilation skill checks)

    • Upright resuscitator (maintains proper sealing of mask during ventilation)

    • Penguin suction (restricts deep suctioning and is portable)