Publication: Institutionalizing the Management of Sick Young Infants:Kenya’s Experience in Revising National Guidelines onIntegrated Management of Newborn and Childhood Illnesses
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2023-04-13
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Global Health Sciences And Practices
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Introduction:In 2015, the World Health Organization (WHO)developed guidelines for the management of sick young infants(SYIs) with possible serious bacterial infection (PSBI) where refer-ral is not feasible. The Ponya Mtoto project was designed as animplementation research project to demonstrate how to adopt theWHO PSBI guidelines in the Kenyan context.Ponya Mtoto Project Description:Between October 2017 andJune 2021, Ponya Mtoto was implemented in 4 Kenyan countieswith higher infant and newborn mortality rates than the nationalmean. A total of 48 health facilities stratified by level of serviceswere selected as study sites.Implementation Approach:The following activities were done toinstitutionalize the management of SYIs with PSBI where referralis not feasible in Kenya’s health system: (1) participating in acocreation workshop and development of a theory of change;(2) revising the national integrated management of newbornand childhood illnesses guidelines to incorporate the manage-ment of PSBI where referral is not feasible; (3) improving avail-ability of essential commodities; (4) strengthening providerconfidence in the management of SYIs; (5) strengthening aware-ness about PSBI services for SYIs at the community level; and (6)harmonizing the national integrated management of newbornand childhood illnesses guidelines to address discrepancies in thecontent on the management of PSBI. In addition, the project fo-cused on strengthening quality of care for SYIs and using imple-mentation research to track progress in achieving project targetsand outcomes.Conclusion:Using an implementation research approach to intro-duce new WHO guidelines on PSBI where referral is not feasibleinto Kenya’s health care service was critical to fostering engage-ment of a diverse range of stakeholders, monitoring provider skillsand confidence-building, strengthening provision of key commodi-ties for managing SYIs with PSBI, and sustaining community-facilitylinkages
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Revising health workplans markedly reduced theaverage number of stock-out days of essential anti-biotics and other commodities, noted as a key barrier tothe management of sick young infants (SYIs) withpossible serious bacterial infection (PSBI).nStrengthening provider knowledge, skills, andconfidence through on-the-job training and professionaldevelopment led to an increase in the number of SYIswho were correctly classified, documented, and treated.nStrengthening community linkages to primary healthcare facilities by training community healthvolunteers (CHVs) on the identification, promptreferral, and follow-up of SYIs, resulted in anincrease in the number of SYIs with PSBI referred toprimary health care facilities.