P0262 - Implementation of the Helping Babies Breathe Programme in the Kurdistan Region of Iraq

Background:
Helping Babies Breathe is an evidence-based educational program for neonatal resuscitation
training in resource-limited areas. It was developed by the American Academy of Pediatrics, and since
2010, implemented in many countries worldwide including the Kurdistan Region of Iraq.
Despite the agreement of the regional regulatory, health, and educational institutions that the
program is of the utmost importance for the safety, quality and outcomes of the maternal and child
health care services in the region, and the extensive training, the actual implementation of the HBB
procedures in the health facilities has been limited.

Objectives:
The aim of the study was to explore experiences of nurses, midwives and hospital administrators with
the implementation of the HBB Program in clinical practice.
Methodology:
The qualitative study was conducted in April 2020 in the Erbil Governorate of the Kurdistan Region of
Iraq and involved health facilities that previously participated in the HBB training. The permission to
conduct the research was obtained from the Erbil General Directorate of Health. The researchers
conducted 8 semi-structured online individual interviews due to current Corona virus restrictions. The
interviews were audio-recorded with the permission of the participants, translated if necessary,
transcribed verbatim, and analyzed using thematic analysis. All the participants were given the
participant information sheet and the informed consent, and socio-demographic data were collected
prior to the interviews. The purposive research sample consisted of 6 females and 2 males including 5
nurses and midwives, 1 hospital head nurse and 2 hospital administrators from a total of 6 health
facilities.

Results:
Analysis of the results demonstrated very positive experiences of all participants with the HBB training
in their facilities and interest in further training in maternal and child health programs, but there
were challenges with practical application. The implementation of the HBB procedures was much
more successful in the smaller facilities with fewer deliveries, which also reported better
inter-professional teamwork and support of hospital management. The larger maternity hospitals had
more difficulties with HBB implementation due to large workload, organizational challenges, poor
teamwork, and lack of interest and support of the management.
Further factors limiting the implementation of the HBB Program included the level of education of
nurses and midwives, staff shortages, lack of written guidelines but also poor public awareness of
maternal and child health. The administrators of the hospitals highlighted the influence of the external
factors on the functioning of the health facilities.

Conclusion:
The results indicate that HBB training in the Kurdistan Region of Iraq is progressing well, but health
facilities need continuing support in the implementation of the program.

Recommendations:
Further research is needed to explore the individual factors affecting the implementation of the HBB
Program in health facilities in more detail.