HURAPRIM is an international collaborative project on Human Resources for Primary Health Care in Africa. Five African countries are partners in the consortium, to give results representative of different parts of Africa: Mali, Sudan, Uganda, Botswana and South Africa. The first aim of the HURAPRIM project is to arrive at a better understanding of the scope and causes of the deficit in human resources for primary health care in Africa, with a view to then developing interventions to address this problem. Since the start of the project in March 2011, MUST has been working on; the literature review, participatory research and a confidential enquiry into maternal and child deaths.
Confidential enquiry into maternal and child deaths in Uganda, aims at prioritising how human resources for health could best be used in order to achieve the Millennium Development Goals 4 and 5 (reducing maternal and child mortality). The confidential enquiry is revealing that quality of human resources is as important as quantity, if not more. It has transpired that this process is in itself a promising intervention to improve quality of care and to inform public health policy on allocation of human resources, and is therefore a being proposed that the process be scaled up in the next phase of HURAPRIM.
In Uganda, we are piloting the confidential enquiry in two sub-counties (Rugando and Nyakayojo) in Kinoni Health sub-district, in Mbarara district which is south-west of the capital. We started in Rugando in October 2011, Nyakayojo was added in February 2012, and Kibuli Parish, Makindye Division, Kampala district, was added in May 2012. These areas were selected because the study team already had good local connections and was confident it would be able to conduct the study to a high standard. Healthy Child Uganda has been working to build up teams of voluntary Village Health Teams (VHTs) in Kinoni health sub-district for the last 10 years, and there is already a system for reporting births and deaths, and a monthly meeting of VHTs in different areas to discuss any child deaths that do occur.
In Kinoni (Uganda) so far 48 deaths have been reported, of which 35 have been analysed. The number of deaths was close to what had been expected except in one parish where the number of deaths was about three times greater than expected. All maternal deaths at Mbarara Regional Referral Hospital since October 2011.Total deaths: 24 Investigated: 23
The information collected from the interviews and medical records is collated and summarised by the fieldworkers and researchers, and presented to a regular monthly panel meeting. In most cases, the maternal deaths are reviewed in a separate meeting from the child deaths. The meetings are mostly held in a hospital. The panel are led by a doctor (paediatrician, obstetrician, or family physician) and also includes other health workers from the hospital and the community plus village health worker representatives. Training for panel members was done with input from experienced case review panel members from the UK. Although it is not always possible for external members to attend every case review meeting, a system of external supervision was set up, and all cases are reviewed externally as well as by the local panel.
The panel is tasked to determi ne the most likely cause of death, identify avoidable factors, and to make recommendations on how such factors could be avoided in future (with a particular emphasis on how human resources could better be deployed).
HURAPRIM MUST team is comprised of the following;
- Dr Vincent Mubangizi-Local coordinator
- Dr Kumbakumba Elias- PI for child death investigation
- Dr Joseph Ngonzi-PI –for maternal mortality investigations
- Dr Edgar Mulongo-PI –participatory research
- Dr Sam Maling-advisor on ethical issues
- Ass Prof Jerome Kabakyenga-Provides overall/oversight leadership
- Dr Francis Bajunirwe- Literature review
- Kyokushaba Christine-Research assistant
- Natukunda Slyvia –Research assistant
- Mwesigwa Douglas-Research assistant
- Ayebazibwe Pedson-Research assistant
- Turinawe Ezra-Project Administrator
So far for Child deaths the following recommendations for primary health care have been made
- Provide basic in-service training, follow-up and supervision in management of severe childhood illnesses to staff in HCII/III/IV and private clinics and drug shops
- There should be funding earmarked for the Medical officer in the HCIV to supervise private clinics / drug shops.
- Increase levels of trained health staff at HCII and HCIV
- Ensure antimalarials and bednets are always given during antenatal visits
- Provide training to TBAs to recognise and refer severely ill babies
- HCIV needs to procure or acquire newborn resuscitation equipment and have midwives trained in newborn resuscitation
And the Recommendations below have already been implemented
- Filing of medical records on the paediatric ward has been improved
- Nursing students have been asked to help monitor critically ill children
- Artesunate is now recommended by the MoH but not yet available in the government supply chain for the treatment of severe malaria
- High-risk antenatal clinic has started at MRRH
- Referred patients are now being accompanied more often
- 2 oxygen heads have been obtained
- Triage system has been started at MRRH