Monitoring and Supervision of Health Workers’ Competencies and the Application of the Neonatal IMCI Strategy in Bolivia and Nicaragua
In Bolivia an interviewer verifies a professional’s immediate newborn care and neonatal resuscitation competencies through a simulation.“This methodology is very practical and allows us to know whether what we have taught in the IMCI workshops is being applied” said one participant from the validation team in Bolivia.
In the Americas, around 3% of newborns suffer asphyxiation at birth and it is estimated that 39,102 neonates died from this cause (29%) in 2006. An equal number of survivors suffer some neurological disorder and brain damage. A majority of these neonatal deaths (during the first 28 days of life) can be prevented with simple measures such as clean delivery, effective management of complications (such as asphyxiation and infections), and early breast feeding. Human resources constitute a factor of critical importance in the implementation of interventions, which means that plans to develop the health workforce so that it meets the needs of the community, as well as systems of supervision, logistics, reference and follow-up and monitoring are essential measures.
It is crucial that health care workers have an understanding of and can carry out basic essential newborn care interventions including recognition of warning signs during pregnancy, delivery, and immediate care after birth. Health workers must also be able to perform prompt and timely resuscitation to prevent neonatal deaths by asphyxia and neurological sequelae, in addition to assisting mothers to provide early breastfeeding to newborns.
Traditionally the supervision and monitoring process consisted of a set of questionnaires for health workers, in addition to instruments for the verification of the availability of supplies, drugs, and basic equipment in a health facility. However, this modality of monitoring demonstrated little effectiveness since it did not permit the assessment of health workers’ competencies. In this context, the national team in Bolivia prepared a new Neonatal IMCI instrument for monitoring and supervision, this time aimed at measuring the competencies of trained health workers. Validation of the instrument, which was made possible through the PAHO-USAID project and conducted in Santa Cruz de la Sierra, Bolivia, demonstrated through a series of methodologies the usefulness of confirming the essential competencies of health workers. These competencies focus on specific critical moments of care for pregnant woman (e.g. labor), immediate care for the newborn and neonatal resuscitation. In May 2008, PAHO convened a new workshop in which participants from 6 countries further adapted the instrument to a Regional version and initiated its adaptation for Nicaragua.
The Follow-up and Monitoring of Neonatal Clinical IMCI instrument was well received in Bolivia and Nicaragua. It permits verification, documentation and strengthening of the competencies of health workers trained in neonatal IMCI and therefore has great potential for future adaptation. Currently more than 10 countries of the Region, including the Dominican Republic, Guatemala, and Honduras, are interested in this methodology and are setting up workshops for national adaptation and use at local health facilities.