SANRU - Improving Maternal and Newborn Health Care in DRC
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DRC is a country with very poor health indicators as far as maternal and infant/child health is concerned. Sanru´s project aims to improve maternal and neonatal care in DRC, through accelerating the conversion of nurses to midwives, rehabilitation and equipment of maternity wards and improving overall delivery care in two priority provinces in DRC (Kasai and M...
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DRC is a country with very poor health indicators as far as maternal and infant/child health is concerned. Sanru´s project aims to improve maternal and neonatal care in DRC, through accelerating the conversion of nurses to midwives, rehabilitation and equipment of maternity wards and improving overall delivery care in two priority provinces in DRC (Kasai and Maniema). The project also includes a community mobilization aspect to ensure that utilization of services is optimal by all categories of population in need, especially vulnerable women and young people. Sanru will work in partnership with two nursing schools that will conduct the training, one school in each respective province. The curriculum has been developed by the Ministries of Health and that of Higher Education with technical support from UNFPA. Further improvement of skills for in-service maternity care staff will be performed, to ensure the skills of already trained midwives are up-to-date. One Swedish academic institution with expertise in midwifery will be relied upon to fulfil a quality assurance function, to ensure the academic training provided as well as the continued development of the midwives is in line with the international standards established by WHO as well as the International Midwifery Council (IMC). The strengthening of human resources for maternity and neonatal care will be accompanied by improvements in physical infrastructure for delivery care, by providing basic maternity equipment as well lighting (using solar energy) in maternities in need. Conditions for better sanitation and hygiene will also be enhanced at a number of maternity wards. Behavioural change in communities will be boosted by a number of activities to fight negative cultural attitudes, raise awareness on available services and to promote utilization of services, including family planning. The project will support the conversion of 240 nurses into midwives and will rehabilitate and provide basic maternity equipment, including lighting system using solar energy and water systems to 100 maternities (in hospitals and health centers). The project is expected to contribute to an annual increase of utilization of maternal, neonatal, child and adolescent health (MNCAH) services by 3 % and to reduce maternal mortality rate by 7% by 2021.
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Total aid 89,386,329 SEK distributed on 0 activities
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Result
The Bomoyi project has delivered remarkable results and succeeded in reducing maternal mortality and improving demand and uptake for RMNCAH services. This has been done by increasing the number of skilled midwives, renovating, and equipping health centers and investing in behaviour change communication among youth and adolescents. In total Sanru renovated 33 health centers and constructed 29, thus improving the availability of services. Based on available data from SNIS and DHIS2, there is an increase in attendance at the project supported health facilities, during the implementation of the project compared to the pre-intervention period. The maternal death rates significantly decreased from 131 and 204 per 100,000 NV (live births) in 2019 to 33.9 and 76 per 100,000 NV in 2022 in Kasai and Maniema respectively. The neonatal death rate showed declining trends from 1.80 and 5 per 1000 NV in 2019 to 1.17 and 3.4 per 1000 NV in 2022 in Kasai and Maniema respectively. As demonstrated in the graph below, the rates recorded in Bomoyi supported health facilities in the 2 provinces over the years have been far lower than those recorded at the national level (547 deaths per 100,000 births in 2020 according to UN MMEIG 2022). The project contributed to increasing the coverage of midwives per 1000 inhabitants. In Kasai province it increased from 0.05 to 0.20 and in Maniema province from 0.4 to 0.83, this is more than a 100% increase. Despite this achievement, the two provinces have not met the WHO recommendation of having 1 midwife per 1000 inhabitants. The total number of midwives increased from 134 in 2019 to 374 in 2022 for the two provinces. At the end of 2023 all the project supported health facilities had at least one midwife that had been trained by the Bomoyi project. The increase in number of midwives contributed to increasing the average rate of people seeking curative services (such as treating malaria or diarrhoea), which rose from 61% to 66% between 2019 and 2022 respectively in the Bomoyi supported health facilities. When parents (in this case mostly women) came to seek curative services for sick child, the midwife would take the opportunity to also offer relevant RMNCAH services/information. The proportion of women who used Ante natal care (ANC) increased from 54% to 70.7% between 2018 and 2022, and the ANC completion rate also increased from 60% to 71% between 2019 and 2022 in Bomoyi supported health facilities in two provinces. In the two provinces, 97.9% of women had their deliveries conducted by skilled personnel (midwife) with a fully completed partogram in the project supported health facilities in 2022. The health facilities supported by the project in the two provinces achieved good coverage of assisted childbirth, with the annual average remaining above the national level and the objectives set by the provinces (80%). The average of post-natal consultations also increased from 74.2% to 80.3% between 2019 and 2022. There has been a visible increase in the uptake of family planning (FP) products, with a 16.3 % average uptake between the two provinces. Most of the new uptakes have been after visiting (or having been in touch with) a midwife, second highest is through the youth clubs (where the BCC interventions have been targeted) and third highest through pharmacies. 54,843 clients accessed contraceptive methods in the community or at project supported health facilities. With support from Gothenburg University, Sanru piloted an 18-month conversion training curriculum (for nurses to become midwives), which elevated the training to international standards. Thanks to the successes of the project, the Ministry of Higher Education and Universities approved the new curriculum to be used for conversion programs of A1 and A2 nurses who which to become midwives. Gothenburg University worked with Sanru for two years to build the institutional capacities of the Technical and Medical Institutes (ISTM), which elevated the standard of the midwifery training and the capacity of midwives. UGOT also assisted to publish some studies on DRC and the work being delivered by Sanru to showcase the impact of investing in midwives to improve maternal and child health, as well as Sexual and Reproductive Health.
This intervention aims at improving maternal and newborn services in two provinces (Kasai and Maniema) by increasing the number of qualified midwives, improving the physical environment in selected maternities (equipement, lighting, and WASH) and mobilizing communities for behavioral change and increased utilization of sexual and reproductive health services. This package of activities is expected to contribute to reduced maternal and neonatal mortality in the country.
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