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Empowering and Equipping Children's Primary Care Nurses in Uganda (Updated January 6, 2015)

Reducing child morbidity and mortality is a primary goal for LifeNet International. After successfully increasing quality of care at 51 partner health centers in Burundi, we now want to test the efficacy of our franchise model in Uganda. Our holistic franchise bundle includes monthly on-site medical training for primary care nurses through a curriculum designed to improve the health of children in utero to 5 years old so that all children thrive. Because Uganda has health needs that are distinct from Burundi, we need to discover how to adjust the curriculum to the local needs in order to successfully apply our model.

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In Burundi, a country with fewer than 350 doctors for a population of 10 million, nurses deliver 80% of all health care. LifeNet operates at the frontlines of the healthcare system by delivering medical training directly to nurses. Our approach stresses knowledge transference and local ownership: our medical education experts work closely with local nurse trainers, who then train partner clinic staff on-site once a month. We designed our curriculum for the local context and to align with the priorities of Burundi’s Ministry of Health, as well as the international community’s Millennium Development Goals and Post-2015 Development Agenda. The lesson plan covers best practices for addressing HIV/AIDS, malaria, reproductive health, maternal, neonatal and child health, and more. 

Uganda suffers from similar gaps in the health system that contribute to increased child morbidity and mortality. By extending LN’s social franchise of Medical Training to not-for-profit private health care centers in Uganda, LN will empower and equip primary care providers to deliver the quality of care children ages 0-5 need and deserve.

Prototype and User Perspective:

Prototype:

Stage 1: Identify 12 to 16 not-for-profit community health centers in Uganda that want:
  • To become a LifeNet-franchised partner
  • To begin monthly Medical Training, Assessments, and Review 
  • (STAGE 1 HAS BEEN COMPLETED)

Stage 2. Hire Uganda Country Director to:
  • Register LN as NGO in Uganda
  • Register with the Uganda Ministry of Health
  • Formalize partnerships with the 12-16 not-for-profit community health centers
  • Oversee commencement of Uganda operations
  • (Uganda Country Director has been hired, has begun work on all of the above)

Stage 3: Hire Medical Team:
  • Nurse Trainer (highly experienced Ugandan doctor or nurse with excellent communication skills)
  • Assistant (responsible for distributing patient surveys, filing, data entry, and driving)

Stage 4: Begin Nurse Training with LN’s first cohort of 12-16 partner community health centers:
  • Monthly training sessions (includes both on-the-job and classroom settings)
  • Monthly assessments: LN Nurse Trainer measures progress and reviews areas that need improvement with health center staff
  • Maintain continual feedback cycle between team members and between Uganda and Burundi
  • Optimize Medical Training operations

Stage 5: Assess Pilot after 6-12 months, asking:
  • What is the measurable change in partner health centers
  • Have there been immeasurable changes?
  • Are there identified weak points in the training curriculum?
  • Do the results merit scaled presence in Uganda as they have in Burundi?
  • Would our partners benefit from LN’s 3 other program verticals (Management Training, Pharmaceutical Supply Chain, and Growth Financing)?
  • If yes two the previous two questions, what are the best continuing implementation strategies?


User Perspective: After a health center becomes an official partner and expectations on both sides of the arrangement are clarified, LifeNet begins monthly trainings and assessments. A comprehensive QSC assessment sets the baseline quality measurements for the new partner health center and medical training, starting with "The Basics" begins right away. Trainers cover standard procedures that are not uniformly practiced or applied. Each month, nursing staff review previous lessons, learn new material, and spend time caring for their patients under the oversight of local LN Nurse Trainers (all training and curriculum delivered in the local language of Kirundi, French, Kiswahili, or English). Here, they can ask questions particular to their equipment, environment, and patients. Through follow up assessments, LN tracks the health center's progress and shares the successes and failures with the staff, using it as a teaching tool. After 6 months, health center staff have completed "The Basics" and move onto to "Healthy Mothers & Healthy Children." Progress, monitoring, and evaluation continue, equipping the nursing staff to provide high quality care to infants, parents, and all members of their communities. 

After 1 year of LN partnership, health centers more than double the quality of care they deliver. The average cost: less than $1 per patient visit. 

Story from the Field: Personal stories about the success of basic medical training at health centers highlight the kind of benefit we want to offer to children in Uganda. During one mentoring session in Burundi, a mother brought her four-month-old baby, who was suffering from a fever, into a partner health center where we were performing training. The LifeNet Nurse Trainer saw this as a training opportunity and watched while the 3 clinic nurses performed a consultation. The three nurses diagnosed the baby and decided on three different courses of treatment: each of them lethal given the baby’s age and weigh. Our Nurse Trainer then intervened, compassionately teaching the nurses to use age and weight to calculate the proper dosage of Tylenol to treat the baby’s fever.

Our medical training, which equips and empowers primary care nurses, is effective in helping children to live and to thrive. It is innovative in that is it based on accompaniment and mentorship over time. This accompaniment style develops trusting relationships and leads to lasting behavior change. Over the course of the training, these nurses are also able to train the new nurses at their clinic and beyond, passing along the empowering and life-saving methods. In this way, LifeNet leverages the resources and abilities of local partners to impact child health in their communities. With child health statistics far below the world’s average, child health improvement is especially important in Uganda.

How to Save a Life: Another Story from the Field

It was a few minutes past 9 o'clock in the morning and LifeNet Nurse Trainer Gabriel Ngambe was leading routine training for the day at the Kiremba Health Center in Bururi Province, southwestern Burundi. Before beginning the formal lessons in the afternoon, he was accompanying the clinic nurses as they saw patients. In the middle of a consultation, another nurse hurried into the room with a grave look on his face. 

Earlier that morning around 4 a.m., a woman arrived in labor. At 9 a.m., she gave birth to a healthy baby girl. Shortly after giving birth, however, the hemorrhaging began. The delivery nurse quickly identified the problem but could not remember what to do so he hurried to the LifeNet trainer he knew was there for the day. "You trained us to treat this months ago but I have not seen it and have now forgotten how!" He explained as they strode towards the delivery room. "We need help to save her life."

Gabriel ran into the room, pulling on fresh medical gloves. The mother's blood pressure had fallen dangerously low and she was going into shock. Gabriel quickly leaped into action, adjusting her position to maximize oxygen flow to the brain and working to stop the hemorrhage. A few hours later, she was in stable condition and Gabriel stepped into another room to continue the day's training with the clinic nurses.

This story captures the ultimate results that LifeNet delivers. Off-site trainings and donations are not enough. Primary care givers need on-site coaches who they know and trust. These coaches, LifeNet Nurse Trainers, return to the health centers time and time again to offer continued training, review, assessments, and oversight. Gifts of money, equipment, and training are not enough to overcome the structural barriers to quality health care for children. Long term relationships with health centers and health center staff are essential for the necessary structural change. 

That day, Gabriel saved the mother's life and perhaps even the newborn child who would have been motherless. One of the biggest values in this story, however, is the nurse from the beginning who said, "I have forgotten how!" Thanks to Gabriel and the LifeNet program, he will remember how to treat both mothers and children for the rest of his life. Through continued LifeNet partnership, we are confident that he will begin to pass along his pediatric knowledge, doubling and tripling the reach of our training.

 

Who will benefit from this idea and where are they located?

In the immediate future, children and mothers in Uganda will be impacted by improved healthcare through partner health centers. There, children will thrive through the benefit of quality healthcare, just like they do in communities in Burundi. Our vision is to expand our franchise to 10 countries in Central and East Africa by 2025, doubling the quality of care of over 20 million patient visits—so that children in these communities will thrive.

How could you test this idea in a quick and low-cost way right now?

(See Prototype Above for Logistical Answer) Because Burundi and Uganda have their own unique health concerns, we must test our Burundi curriculum to ensure it addresses the needs of healthcare workers and children in Uganda. We plan to do this through basic research, local surveys and partnerships with local health leaders in Uganda. Basic research is the most accessible way to update our curriculum because health statistics are compiled by many NGOs and are publicly accessible. We can access recent statistics for both Uganda and Burundi and determine what health issues are of greatest importance in Uganda. For example, compared to Burundi, Uganda’s Aids and Malaria rate is 400% higher and maternal mortality rate is 50% lower. Our curriculum designers can use this information to scale the lessons on these health issues accordingly. Local surveys make up an important part of the feedback loop within our Burundi operations. We survey the patients at our partner clinics to make sure their voices are heard and are included in the innovation process. In Uganda, we can use patient and staff surveys to learn about local needs from the mouth of locals. One of the most important benefits of health networks, like LifeNet, is that they allow for high-level coordination of health responses. By maintaining partners with leaders in multiple regions of the country, we can help them collaborate and share both human and physical resources. By creating initial relationships with leaders and learning from them, we can begin to learn what such a collaborative health network should look like in Uganda.

What kind of help would you need to make your idea real?

We need local experts to provide insight and feedback to adjust our curriculum and programming to the needs of the local context. In order to implement our idea, we will need to recruit local staff as Nurse Trainers, Management Trainers, and Assistants. We will need to continue to develop strong relationships with local partners as well as international partners who can help us refine our model through ideas and feedback. Our biggest need is for the funds necessary to research and test our idea through a pilot program in Uganda.

Is this an idea that you or your organization would like to take forward?

  • Yes. I am ready and interested in testing this idea and making it real in my community.
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Attachments (2)

OpenIdeo_Refinement Q&A.pdf

Refinement Q&A, condensed.

OpenIdeo_LN_UserMap.pdf

User Map as PDF

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Photo of Irene Blas
Team

Equipment is key for nurses to make a good job. They can be very good at their job but if they are not fully equipped they cannot make their best. Your job is amazing! Congratulations!

Photo of LifeNet International
Team

Thank you for the encouragement Irene! You are very correct about nurses and we see it everyday. Best regards.

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