1. HBB Status update – Performance Evaluation in Malawi Shivam Gupta Johns Hopkins University – Institute for International Programs

2. Intervention Start in March – April 2011 Thirteen districts selected for the roll-out of HBB –Northern Region: Chitipa, Rumphi & Nkhatabay –Central Region: Nkhotakota, Kasungu, Dowa & Lilongwe –Southern Region: Thyolo, Machinga, Zomba, Phalombe, Nsanje & Mwanza 481 health workers trained till end of Feb 2012 –Registered nurse midwife –Nurse midwife technician –Clinicians –Anesthetic clinical officer 2

3. Specific questions Are newborn resuscitation service delivery guidelines and supplies available according to the national rollout plan? Are the HBB trained health workers able to apply the newborn resuscitation and essential newborn care skills after 12 and 18 months of training? Is the coverage of HBB implementation at facility level consistent with the national roll out plan? What barriers exist in the implementation of HBB at the facility level? What factors have facilitated implementation of HBB at the facility level? What recommendations can be made for improved availability and quality of neonatal health services in Malawi?

4. Methods - Design Quasi-experimental Non-randomized controlled study –13 intervention districts –15 comparison districts Baseline measures using secondary data Two rounds of primary data –12 and 18 months after phased intervention roll out Additional descriptive studies

5. Methods - Instruments ToolDescription Health Care Worker Questionnaire (1 tool) Assess knowledge and practice of HBB to collect information that will inform on the constraints and facilitators to delivery of quality of care and recommendations for ways to improve quality of care. Health Care Worker Tools (2 tools) Two clinical case studies/ simulations for the providers to assess their clinical decision making pertaining to screening, management and treatment pertaining to newborn resuscitation. Direct Observation of Patient Care (2 tools) Two quantitative observation checklists to (1) observe the provider performing labor, delivery, newborn and immediate postpartum and (2) newborn resuscitation skills. Key informant Interview (1 tool) Tool will guide the key informant interviews. The respondents will be asked questions related to strengths, weaknesses and recommendation for improvement for the HBB roll out. Facility Assessment (2 tools) Verification of availability of trained staff and storage conditions of medications, supplies and equipment. Data related to the numbers of newborns that need resuscitation and the type of treatment they received.

6. HBB Malawi Evaluation - Timeline Task Jan – Mar 2012 Apr – June 2012 Jul – Sep 2012 Oct 2012 – Sep 2013 Submit the study protocol for JHU IRBX COMREC IRB ApprovalX Pre-test and finalize study toolsX Train of data collectorsX Conduct first round of facility assessmentX Data cleaning, entry, and analysisX Dissemination of findings and report preparation X Training and preparation for second roundX Conduct second round of facility assessmentX Data cleaning, entry and analysisX Dissemination of findings and report preparation X Final DisseminationX Manuscript preparation and submissionX

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