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.
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.
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.