P0273 - Tajikistan: Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) improve newborn survival

Survival and development of children are a priority for the Tajikistan health system. However, despite a significant decrease in under 5-year mortality from 105 per 1000 newborns in 1990 to 34 in 2017 and decreased infant mortality from 83 per 1000 newborns in 1990 to 31 in 2017, Tajikistan was unable to fully achieve MDG goals.

Since 2012, the Ministry of Health (MoH), UNICEF and LDS Charities (LDSC) have conducted HBB
training programs to strengthen the capacity of medical staffs, adding ECEB in 2016. All delivery facilities countrywide are now equipped with training and clinical equipment, creating work environments that facilitate sustainable application of training knowledge and skills.

In 2017 a baseline assessment was provided to evaluate the capacity of staff for HBB and ECEB and equip all hospitals. In November 2018, the MoH, with technical support from UNICEF and LDSC, issued Order #1037 mandating training rooms in every obstetrical facility. The order has two goals: (1) establish continuous facility based training, (2) set up internal self-monitoring and self-assessment process. To evaluate quality of services, an external supportive supervision system was introduced.

Based on the MoH Order, all delivery personnel must be HBB and ECEB trained, regularly improve knowledge and practical skills, and send training data reports to the MoH. Technical support to develop and establish a supportive supervision system was provided to MoH by LDSC and UNICEF. It was decided by MoH and partners to conduct the annual assessment in 2019.

Implementation of MoH Order: (1) Five technical meetings of 150 managers from 75 obstetrical facilities in four regions to introduce MoH Order and discuss implementation. (2) Independent consultants began external monitoring of all facility staffs

The monitoring tools were developed for annual evaluation including assessment of equipment and conditions of obstetrical facilities, evaluation of staff skills, analysis of statistical data, modeling and assessment of resuscitation skills, certification of staff, interviewing of mothers. Supportive supervision was provided to staff during monitoring visits.

Results of evaluations (baseline and annual) are demonstrated in the graph and show a range of progress in all indicators from 8% to 35%.

The evaluation results show that for a country with limited financial and human resources, implementation of a continuous learning process, internal monitoring and self- assessment system at the facility level, as well as effective supportive supervision at the national level, make key contributions to reducing maternal and infant mortality. In addition, the support of facility health managers is critical to success.

"Abstract expresses personal views and opinions of author and does not necessarily represent UNICEF’s official position", co-author: Mutrib Bahruddinov