TRANSFORMING THE EDUCATION AND TRAINING OF CLINICAL PROFESSIONAL: DELIVERING MATERNAL AND CHILD HEALTHCARE IN MALAWI MELANIE HAMI GLADYS MSISKA.

TRANSFORMING THE EDUCATION AND TRAINING OF CLINICAL PROFESSIONAL:

DELIVERING MATERNAL AND CHILD HEALTHCARE IN MALAWI

MELANIE HAMIGLADYS MSISKA

Presentation Outline

• Project team• Purpose of the project• Purpose of the presentation• Geographic location and Health indicators for

Malawi• Project implementation• Monitoring & Evaluation• Challenges

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PROJECT TEAM

University of Malawi

• Professor David Dewhurst• Ross Ward• Professor Pam Smith• Professor Tonks Fawcett

University of Edinburgh

• Professor Ellen Chirwa• Dr. Melanie Hami• Dr. Gladys Msiska

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PURPOSE OF THE PROJECTThe overall aim of the project is: •to improve and enhance curriculum content and delivery•to further enhance quality assurance processes for specialist maternal and child health programmes in medicine and nursing• to reduce high maternal, neonatal and child mortality - in line with the Millennium Development Goals 4 and 5•to contribute to the post 2015 sustainability goals

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THE PURPOSE OF THIS PRESENTATION

• To demonstrate how programme innovation has the potential to improve and enhance curriculum delivery

• To enable health professionals to work towards meeting Malawi’s Maternal, Neonatal and Child Health needs

• To illustrate the collaborative venture between the University of Malawi and the University of Edinburgh working in partnership to exchange experiences, knowledge and skills to develop online platforms and resources to support learning and teaching

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Malawi: The Warm Heart of Africa

• Situated in the southern eastern part of Africa

• Sub-Saharan Region• Population 15 million

people

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MALAWIMaternal, Neonatal and Child health Statistics

Maternal mortality rate 675/100,000 births Neonatal mortality rate 31/1,000 live births Infant mortality rate 66/1,000 live births Under five mortality rate 112/1,000 live births

(NASO, 2011)

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HEALTH CARE WORKFORCEAgainst this picture of health need, the comparative number of health care workers per 1000 population in Malawi and United Kingdom (UK) is:

Physicians• UK 2.74 per 1000• Malawi 0.02 per 1000

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Nurse & Midwives• UK 10.1 per 1000• Malawi 0.3 per 1000

Rationale for the Project

• Given these high mortality rates in these vulnerable groups, there is an urgent need for advanced medical, nursing and midwifery practitioners.

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ADDRESSING THIS SITUATION• The low density of a specialist trained health care

workforce means there is an urgent need to rectify this situation by implementing innovative education and training

• Our project does this by implementing online learning to support innovative curriculum delivery whereby specialist knowledge and skills can be increased and linked more closely with practice

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WHAT HAVE WE DONE?• Established collaborative partnership for the

enhanced educational provision via e-resources in order to build capacity in maternal and child health

• Building on previous project work which developed a computer managed system (CMS) for undergraduates, a bespoke (moodle) platform called PG CONNECT was developed.

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HOW DID WE DO IT?

• Enhanced IT infrastructure – PCs for students and a new server

• An electronic environment that supports teaching and learning.

• Staff development in modern pedagogies, E-assessment and use of e-learning

• Development of online modules through collaborative partnership to enable distance learning

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HOW DID WE DO IT?

Learning platform development and delivery:– Course Content– E-learning technologies (Moodle)

• Videos, discussion boards, interactive tools

•Student and teacher evaluation through quantitative surveys, qualitative interviews and focus groups•Teacher observation and feedback•Student profiles•Health Facility data bases•Staff profiles

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HOW DID WE DO IT?Student profilesStudents taking the courses:2012-13 MSc Midwifery 4 MSc Reproductive Health 62013-14 MSc Midwifery 10 MSc Reproductive Health 10

MSc Child Health 6

2015-16 Recruitment being processed

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WHAT STUDENTS DO?• Provide advanced maternal and child health care

through direct patient/client care• Provide leadership on maternal and child health care• Resource mobilise • Develop innovative and creative strategies for the

prevention and reduction of maternal and infant morbidity and mortality rate;

• Provide Community Midwifery and child Health care• Provide advocacy role on various issues pertaining to

maternal and child health care. 15

COMMUNITY MIDWIFERY EXPERIENCE – MASTERS IN MIDWIFERY STUDENTS NAMARU

VILLAGE

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MONITORING AND EVALUATING THE CONTEXT OF THE

PROGRAMMESWe are undertaking this project with students who are coming from and returning to challenging and resource poor environments. We are collecting ongoing data from:•Ten identified health facilities•The Maternal and Child Health Indicators: antenatal attendances, maternal conditions and deaths, obstetric complications, newborn complications, including prematurity, sepsis and asphyxia •The staff profiles to identify specialists they have and are acquiring through the MCH masters programmes

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18

0

10

20

30

40

50

60

NU

MBE

R O

F D

EATH

S

DISTRICT HOSPITALS

Maternal Deaths Registered in a Year Per District Hospital - 2014

Dowa

Karonga

Chitipa

Mzimba

Mangochi

Neno

Nsanje

Chikwawa

Chiradzulu

Mwanza

190 500 1000 1500 2000

APH

PPH

PROLABOUR

PREECLAMPSIA

SEPSIS

RUPTURED UTERUS

OTHERS

NUMBER OF CASES WITH THE COMPLICATIONS

OBS

TETR

IC C

OM

PLIC

ATIO

NS

Common Obstetric Conditions Registered by District Hospitals - 2014

Mwanza

Chiradzulu

Chikwawa

Nsanje

Neno

Mangochi

Mzimba

Chitipa

Karonga

Dowa

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0.010.020.030.040.050.060.070.080.090.0

100.0

LIVE BIRTHS FRESH SB MACERATED SB

NND

PERC

ENTA

GE

OF

TOTA

L BI

RTH

S

NEW BORN SURVIVAL CONDITION BY DISTRICT HOSPITAL -2014

Dowa

Karonga

Chitipa

Mzimba

Mangochi

Neno

Nsanje

Chikwawa

Chiradzulu

Mwanza

WHAT DO THESE STATISTICS DEMONSTRATE?

Short term•Quantitatively student and staff profile data shows existing and new specialist qualifications but not able to show impact on indicators as yetLong term

Collecting data over ten years will demonstrate the impact of increased MCH specialist education on maternal and health care indicators.

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THE CHALLENGES • Lack of funding for scholarships because students

can not support themselves• Internet connectivity• Low income and resource poor health and

educational environments • Although there is some move toward achieving

millennium development goal 4 but goal 5 is still a challenge

• Achieving the post 2015 sustainability goals

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Acknowledgements

• University of Edinburgh project team for the technical support.

• The College is grateful to the Scottish Government International Development Fund for the financial support for the project.

• We are grateful to the International Collaboration for Community Health Nursing Research (ICCHNR) for sponsoring our attendance at this conference.

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