Welcome!
Do you know the history of the Kenya Paediatric Association (KPA) and KEMRI-Wellcome partnership?
In this month’s CIN Bulletin, Prof. Fred Were, a long-serving member and Chair of KPA, tells us more about this partnership and his desire for CIN. In our project highlight segment, we discuss the importance of clinical audits and the new tool developed to measure and provide feedback on quality of hospital care provided to sick and small newborns. Be sure to check out the upcoming events segment to learn more about the CLN forum in August and the CIN session at the KPA conference.
July 2021 Updates
- Kenyatta National Hospital (KNH) has been upgraded to a Centre of Excellence by NEST. There are plans underway to establish a mentorship programme on equipment use and guidelines for newborn care.
- Quality improvement (QI) project as implemented by NEST is a structured approach to evaluating the performance of systems and processes in order to assess areas in need of improvement for both functional and operational needs. Phase one of the project will be launched on 9th August 2021 at JOOTRH, Bungoma, Kakamega and Kiambu hospitals. Phase two of the project will be rolled out on 11th October 2021 at Thika, Pumwani, Embu, Nakuru and KNH.
- All NEST sites have been trained on clinical audits for small and sick newborns. Read more about the new clinical audit tool for small and sick newborns in the project highlight section of this bulletin.
- The Comprehensive newborn monitoring chart is now available for download. The charts are to be used for communication, care planning and follow up. Initial reports from health workers who have used the charts show that these charts are appreciated as they are considered a one-stop-shop for all relevant information on a one-paged document.
- A training on Newborn ETAT+ was held at KNH for CIN members based at Mama Lucy and Pumwani Hospitals.
How it all started
How the partnership between KPA and KEMRI-Wellcome birthed the Clinical Information Network
They say two things change the world: people with enough fortitude, conviction and ability; and ideas of how the world can be. The same can be said of the Clinical Information Network, which was established by a small group of people with an unwavering commitment to improving child health in the country. We spoke to one of these people, Prof. Fred Were, a long-serving member and Chair of KPA. Prof. Were does not only possess a rich understanding of CIN’s institutional history, but also played an instrumental role in its formative stages and still plays a significant role to this day.
Q: How did the Partnership between KPA and KEMRI-Wellcome start and how was CIN birthed?
Prof. Were: This partnership started in the mid-1990s. At that time, the Kenya Paediatric Association had almost collapsed, and we were looking for ways to revive it. Around the same time Prof. Mike English was moving from Kilifi to Nairobi and had developed a keen interest on things going on at KPA. As we were rejuvenating KPA, we decided to open up membership to researchers and non-clinicians and, to our joy, researchers from KEMRI-Wellcome aggressively joined KPA. Previously, KPA was associated with the University of Nairobi. In the revival we needed to interest all paediatricians and had a goal of involving them in research activities so that we could further the goal of improving child health in the country. So, in a nutshell, the partnership started because we needed to wake-up a dormant organisation that had been there since 1968, with an expanded focus beyond conferencing, but looking at how else we could improve the lives of children in the country.
Q: How has the partnership evolved
Prof. Were: The relationship has deepened. We started off as people who were concerned with furthering the interests of children. As we have grown, KPA and KEMRI-Wellcome have furthered the relationship beyond that. We have now come into big projects that we do together. The growth has been phenomenal, from the goals of waking up a dormant institution to the establishment of the Kenya Paediatric Research Consortium (KEPRECON); the research wing of the KPA. All along this growth, we have had KEMRI-Wellcome with us, I can not remember a major activity that they were not part of. Together I have seen us grow from a Continuous Medical Education (CME) organisation, to the realisation that CME alone cannot influence policy and practice and ultimately improve child health in the country. Since around 1997, when I became the chair of KPA, I have seen tremendous growth in the partnership with KEMRI-Wellcome.
Q: What value does KPA and KEMRI-Wellcome derive from the partnership?
Prof. Were: The relationship with KEMRI-Wellcome has given KPA international prominence and visibility. The relationship makes us leaders in the industry. KEMRI-Wellcome gains a foothold to a robust professional body with members drawn from the 47 counties. In a sense, we have given ourselves visa-free entry into each other’s lives.
Q: What would you say is the key highlight of this partnership?
Prof Were: As KPA, within our framework of work, we never knew that we could get funds for research. When KEMRI-Wellcome provided us with our very first sub-grant of 20,000 U$D back then, we never knew that a different world of possibilities would open up to us. Since then, we have gone on to do bigger things, including the introduction of the pneumococcal vaccine in Kenya, but I will always remember that first grant.
Q: What are some of the challenges you have encountered over the years, and how did you work around them?
Prof Were: When we decided to create the KEPRECON away from what we call the political KPA. At times KEPRECON is better understood by KEMRI-Wellcome than members from KPA. From time to time, we have had to explain these nuances and differences to our members.
Q: What is the next big thing in the relationship?
Prof Were: For the first time, we initiated a funding opportunity from the KEPRECON side and advanced a slice to KEMRI-Wellcome; otherwise, it has always been the other way around. The next big thing is to get the CIN to have a home outside the KEMRI-Wellcome environment. By that we mean, that the government should take it over, with KPA and KEMRI-Wellcome staying on as experts. We need to persuade the government of the day that they are the ones who should handle this. If this happens within my lifetime, I can handover over the legacy to those who were born after me.
Project highlight
A newborn clinical audit tool for hospitals in Kenya
A new clinical audit tool has been developed to measure and provide feedback on the quality of hospital care provided to sick and small newborns during the first 28 days of life. Clinical audits provide a clear and systematic framework for monitoring gaps in the care provided with the goal of improving quality of care in a systematic and collaborative way. The newborn audit tool provides a structured record form to ensure all vital information is recorded accurately hence allowing retrospective data analysis.
For many years, clinical audits for maternal and perinatal care have been implemented in Kenya through the Maternal and Perinatal Death Surveillance and Response (MPDSR). Information from this audit has gone a long way in improving hospital care, service delivery, accountability and further development of relevant health policies. Although the MPDSR provides relevant information for maternal care, the perinatal aspects focus on stillbirths and the immediate care of the live newborn, leaving an information gap in the delivery of care to small and sick newborns.
Through clinical audits, medical practitioners can identify emerging trends and patterns of morbidity, mortality, modifiable factors and interventions to improve the quality of care and outcomes in hospitals and other health care facilities. Additionally, audits provide feedback for health workers to improve health care practises
Guided by the WHO guidelines, the newborn audit involves all key stakeholders while taking a collaborative approach. This audit focuses on a bottom-up approach starting at the hospital level.
Well-conducted clinical audits are not just a regulatory requirement by the Ministry of Health. Neither are they a report writing activity or an opportunity for apportioning blame among clinical colleagues. Clinical audits provide an opportunity for learning and continuous improvement. Systematic audits remove the person from the incident and focus on the gaps and ways of improvement.
The experience from other audits such as the MPDSR suggests that clinical audits are an effective means to improving care. However, the success of an audit is dependent on the implementation of recommendations. As of July 2021, all NEST sites had been trained on implementation of this audit. Currently, plans are underway to train the other remaining hospitals.
This article is based on an interview with Dr Muthoni Ogola from one of the hospitals in the CIN, who developed and piloted the tool to conduct clinical audits for care given in the NBUs as part of her PhD research.
Network Members
Tribute
In Loving Memory of George Obop who until his demise on 30th October 2020 was a Health Records Information Officer (HRIO) at the Kisumu county hospital. George is remembered by his colleagues as a strong, dynamic and hardworking colleague who was ever ready to listen and assist his team members. He was a vocal champion on the importance of quality data and provided guidance to various departments on documentation. CIN is very grateful for the work George did in growing and supporting the Network
New members
Upcoming Event
We plan to hold a one-day workshop of the partners participating in the Clinical Learning Network and the SEARCH trial. The aim of the workshop is to co-develop the training and mentorship package that will be implemented over the duration of the CLN project. We also plan to sensitise the teams from the ten hospitals participating in the SEARCH trial on the study in preparation for resumption following suspension in April 2020.
Have you registered for the KPA Conference? The Annual Scientific Conference will be held virtually from 24th – 26th August 2021 under the theme “Little feet, big steps. Prioritising child health in a rapidly changing world”. Join the CIN team at the conference on Thursday 26th August 2021 from 10:00 am – 1:00 pm at the Track 4 session for a discussion on quality standards, training, clinical audits and much more. Click here to register
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You can email your feedback and recommendations to cin@kemri-wellcome.org
The Clinical Information Network (CIN) is a collaboration between the KEMRI Wellcome Trust Research Programme (KWTRP), the Ministry of Health (MOH), the Kenya Paediatric Association (KPA), the Kenya Paediatric Research Consortium (KEPRECON), and participating County Hospitals in Kenya. CIN was established in 2013 to support the use of information to improve hospital care for children and newborns admitted to county hospitals, and to further guide policy and practice in each county in Kenya.
*Cover Photo: courtesy of UNOPS