1. EmONC Scale-up In Kenya Results of Health Facility Assessments
EmONC Toolkit
Appendix 12
EmONC Scale-up In Kenya Results of Health Facility Assessments
February 2017

2. Activity Objective
To increase the proportion of sampled facilities with capacity to offer all the signal functions for basic emergency obstetric and newborn care (BEmONC) to at least 50% from baseline

3. EmONC Signal Functions
BEmONC 1
Administer parenteral antibiotics 2
Administer uterotonic drugs 3
Administer parenteral anticonvulsants 4
Perform manual removal of the placenta 5
Remove retained products of conception 6
Perform assisted vaginal delivery 7
Perform basic neonatal resuscitation
CEmONC: All seven BEmONC signal functions plus 8
Perform Caesarean delivery 9
Provide blood transfusion

4. Scale-Up Coverage Areas
17 counties selected based on mortality burden and geographical spread

5. Counties Targeted for EmONC Scale-Up
Muranga
Busia
Tharaka Nithi
Nyamira
Meru
Nairobi
Kitui
Mombasa
Samburu
Kilifi
Wajir
Turkana
Mandera
Kakamega
Baringo
Narok
Trans Nzoia

6. Number of Facilities Surveyed by County
(Available data as of August 2016)
County
Tier 2
Tier 3 /4
Total
Baringo 15 5 20
Busia 36 4 40
Kitui 32 9 41
Mandera 27 6 33
Meru 28 55
Muranga 3
Narok 10 13
Nyamira 26
Samburu 18
Tharaka Nithi 7
Trans Nzoia 23 8 31
Wajir 17
142 63
335

7. Conceptual Framework High-quality data for decision making
Make equipment available IV
Provide monitoring, supervision and feedback
Improved process of care (service delivery)
Improved outcomes (reduced morbidity and mortality) II
Make guidelines and job aids available
III
Provide training for health workers
High-quality data for decision making

8. Results of Wave II Facility Assessments

9. Availability of Guidelines
Guidelines & Job Aids
Surveyors were asked to confirm the availability of the National Guidelines for Quality Obstetric and Perinatal Care by visual inspection
Availability varied from 20% to 100% with better general performance in hospitals than in health centres/dispensaries

10. Availability of Guidelines
Guidelines & Job Aids

11. Staff Training on BeMONC
Train Health workers
The proportion of staff trained on BEmONC is generally low in all counties except Murang’a.
No health workers have been trained on BEmONC in hospitals surveyed in Narok County.

12. Staff Trained on BEmONC
Train Health workers
(in Preceding 12 months)
OVERALL %
BAR
28%
BUS
37%
KIT
19%
MAN
27%
MER
11%
MUR
67%
NAR 4%
NYA
35%
SAM
34%
THA
13%
TRA
14%
WAJ
21%

13. Availability of Equipment/Drugs
Available Equipment
Health facilities were assessed for the availability of key drugs and equipment required to provide the seven signal functions of BEmONC
Surveyors were required to record the availability of various items after visual confirmation

14. Signal Function 1: Availability of Parenteral Antibiotics
Average performance in hospitals
Generally poor performance in health centres/ dispensaries
Complete absence of broad-spectrum antibiotics across Tier 2 facilities in Muranga and Narok counties

16. Signal Function 2: Availability of Oxytocin
Oxytocin generally widely available across surveyed facilities
Data missing for a few facilities in Baringo and Meru

18. Signal Function 3: Availability of Anticonvulsants
Magnesium sulphate generally widely available across hospitals
Tier 2 facilities showed average performance

20. Signal Function 4: Manual Removal of Placenta (MRP)
Elbow-length sterile gloves are recommended for manual removal of the placenta.
These gloves were not available in many lower level (Tier 2) facilities.

22. Signal Function 5: Removal of Retained Products of Conception
Hospitals performed better than Tier 2 facilities
Data missing for some facilities in Meru and Busia counties

24. Signal Function 6: Assisted Vaginal Delivery
Good performance for Baringo, Kitui, Muranga, and Trans Nzoia counties
Tier 2 facilities across all regions performed below 50%

26. Signal Function 7: Newborn Resuscitation
Neonatal BVM device generally widely available at both Tier 2 and hospital levels
Tier 2 facilities in several counties performing below 75%

28. Conclusions
A multipronged approach is required to achieve the overall objective, targeting availability and use of guidelines/job aids and training to use them and also availability of appropriate, functional equipment and consumables.
Training needs require urgent attention.
High-quality, timely data allow for rapid and appropriate action planning.

29. Next Steps
Finalize data analysis and develop facility/county profiles.
Convene county teams for action planning.
Incorporate quality improvement in work plans and implementation.
Implement these steps.
Evaluate performance over time:
Only possible for facilities included in successive surveys
Refine tools based on continuous feedback.

30. MEASURE Evaluation PIMA is funded by the U. S
MEASURE Evaluation PIMA is funded by the U. S. Agency for International Development (USAID) through associate award AID-623-LA and is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in partnership with ICF International; Management Sciences for Health; Palladium; and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States government.