National HBB Implementation in Malawi Is Moving Forward


HBB bag and mask ventilation training at Mulanje College of Nursing, Mulanje, Malawi Photo: AAP 

Malawi’s Helping Babies Breathe® (HBB) implementation program is a district-based comprehensive effort targeted at nationwide needs for neonatal resuscitation. The Ministry of Health (MOH) is actively involved as convener of a multiple partner initiative that is expanding.    

The first stakeholder’s meeting took place in early March 2011. District-based training and HBB implementation proceeded this meeting. In addition to the MOH. Save the Children (Malawi), Maternal and Child Health Integrated Program (MCHIP), JPIEGO and others have been involved in the roll-out of HBB in Malawi. Funding sources include USAID, Johnson & Johnson, and Laerdal Global Health. The public-private foundation model of the HBB Global Development Alliance (GDA) is operationally apparent in country.

As of October 2012, there have been 1,254 total skilled birth attendants trained in Malawi since the inception of HBB. In total, 94,251 providers have been trained around the world since the roll-out of HBB in June 2010.

The Malawi MOH HBB program was initiated in March 2011 following an EmoNc (emergency medical obstetric newborn care) assessment. This assessment indicated that knowledge and skill competencies in newborn resuscitation had a satisfactory level of less than 33%. The national HBB implementation as an evidence-based intervention integrated within the Maternal and Newborn Health package has Victoria Shaba as HBB Coordinator and Trainer. HBB implementation has progressed in a methodical, progressive fashion organized by districts. By August 2012, 115 health workers had become Master Trainers and 622 health workers from implementing districts were trained as service providers.  

Pre-service HBB education and implementation in training colleges implementing Essential Newborn Care (ENC) began during the July to September 2012 period. Save the Children, with a grant from MCHIP, is responsible for this significant scaling-up of HBB into the professional schools. For example, colleges implementing HBB within ENC in August 2012 included Trinity College of Nursing and Midwifery, Holy Family College of Nursing and Midwifery, Malamulu College of Health Sciences, Mulanje Mission College of Nursing and Midwifery, and Ekwendeni College of Nursing and Midwifery.  The total number of training colleges involved is now much longer with several hundred faculty and students involved.

The second annual stakeholders’ meeting in February 2012 in the capital Lilongwe, drew an energetic group that included partner organizations and representatives from the districts such as District Health Officers. Quantitative and qualitative details of local efforts were included in presentations. District level reports were presented and active discussion and problem solving of issues such as availability and distribution of equipment took place. Pre-service training was discussed. Plans for a new training and implementing partner, Latter Day Saints Charities, were presented as part of future oriented discussion. Continuation of annual stakeholder meetings is anticipated for the future. 

HBB equipment explanation, Mulanje College of Nursing, Mulanje, Malawi Photo: AAP

Very evident at the second stakeholders meeting, day-to-day operations and field visits, is the realistic awareness of the challenges of countrywide implementation that includes not only initial training and equipment but also ongoing maintenance and evaluation, quality improvement and outcome assessment. An evaluation research project under the direction of the John Hopkins University School of Public Health is underway with its data collection phase in targeted districts. Data collection utilizing a district case registration paper format is being pursued. Expanding and sustaining this second phase of HBB implementation is a priority while efforts are made to reach out to districts where training has yet to take place.

The American Academy of Pediatrics (AAP) has been actively engaged in the Malawi HBB implementation from the start and is committed to continuing its support. The AAP provides information, facilitation and technical assistance resources as well as being the developer and custodian of  the HBB curriculum. In Malawi, the AAP is providing mentorship to on-the-ground implementation activities and strategizing among partnering organizations countrywide. As a neonatologist with clinical, programmatic and global health experience, I have been served as a representative of the AAP and of the HBB Global Development Alliance in training; evaluation;  communication between the Malawi MOH and partner organizations; and planning efforts that include integration of new partners.

Implementation of HBB in Malawi will continue as a center of excellence in the country’s efforts to meet Millennium Development Goal #4, reduction of child mortality. HBB was not developed to be isolated or compartmentalized and it certainly is not in Malawi. It is integrated with MOH comprehensive reproductive care efforts and policy.  Future plans include Malawi’s involvement in the recently announced World Health Organization (WHO) global effort, Born Too Soon to confront prematurity; as well as the recently emergent Survive and Thrive public-private GDA that includes USAID. The current HBB initiative in Malawi has moved forward rapidly and can be expected to be part of these and other future efforts.


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