Abstract
Neonatal mortality accounts for 45% of under-5 mortality worldwide, with 98% of newborn deaths occurring in developing countries. The Dominican Republic (DR) demonstrates one of the highest neonatal mortality rates in Latin America despite broad access to care. Strategies to support professional capacity building and strengthen the local health care system are needed to improve neonatal outcomes in the DR. Helping babies breathe (HBB) and essential care for every baby (ECEB) are evidence-based newborn resuscitation and essential care training programs that have been shown to improve providers' confidence, knowledge, and clinical skills. Lack of professional support and infrequent resuscitation skills practice are commonly cited as barriers to skill retention after HBB training, while establishment of program mentoring and regular skills refreshers are associated with retention of clinical knowledge and skills and improved clinical performance and outcomes. Global partnerships to facilitate implementation of a comprehensive newborn resuscitation and essential care training program with ongoing clinical and program mentorship in the DR should have a lasting impact on workforce capacity, quality of care, and clinical outcomes. A multidisciplinary, international group of clinicians partnered with the Ministry of Health to design and implement a comprehensive newborn health initiative in the DR. A train-the-trainer model structured the regional rollout of a combined HBB/ECEB program with integrated quality improvement (QI) initiatives and systems for ongoing program monitoring, reinforcement, and mentorship. Cognitive, affective, behavioral, and clinical outcomes are being measured. Seventeen local champions representing six hospitals participated in the HBB/ECEB master trainer course and design of a QI tool for site-specific clinical performance monitoring. One hundred seventy-eight and 171 providers participated in HBB and ECEB courses, respectively, at pilot sites during the following year. Participants completed prior training need assessment, pre-/post-knowledge assessments and course evaluations. Program mentorship and monitoring of continuing education and clinical performance are ongoing. The Ministry of Health has assumed responsibility for program sustainability and current scale-up, including integration of maternal resuscitation training. International partnerships facilitated the collaborative implementation of scalable, locally sustainable newborn resuscitation and essential care training in the DR, mobilizing local resources and empowering the workforce to capably pursue improved care of an exceedingly vulnerable community.
Highlights
Neonatal mortality, defined as death within the first 28 days of life, accounts for 45% of under-5 mortality worldwide
Unlike many under-resourced countries where high neonatal mortality rates correlate with widespread lack of health-care access, the Dominican Republic (DR) has a comprehensive infrastructure consisting of primary, secondary, and tertiary-level health-care facilities that provide strikingly inclusive coverage: 99% of all deliveries in the DR are reported to take place in health facilities and 98% of deliveries are reportedly attended by skilled birth attendants [5,6,7]
Outcome evaluations and policy analysis based on ongoing data collection and program scale-up are forthcoming. This evaluation will assess the design and implementation of a neonatal health intervention composed of dual Helping babies breathe (HBB) and Essential Care for Every Baby (ECEB) training, provision of clinical neonatal resuscitation equipment, introduction of quality improvement (QI) monitoring, and establishment of a mentoring framework to support ongoing education in the northern region of the DR
Summary
Neonatal mortality, defined as death within the first 28 days of life, accounts for 45% of under-5 mortality worldwide. Utilizing partnerships to support the investment of resources for newborn resuscitation and essential care and further implementing high-impact interventions to promote professional capacity building and ongoing supervision within the maternal–infant health workforce should address major limitations of the quality of health care and contribute to improved neonatal outcomes in the DR. Essential Care for Every Baby (ECEB) is a companion training program that reinforces basic interventions in newborn care and has been demonstrated to improve health-care providers’ confidence, knowledge, and skills related to newborn care in the first days of life in resource-limited settings [14]. Lack of local professional support, infrequent resuscitation skills practice, and transitory nature of maternal–infant workforce are commonly cited as barriers to skill retention, while establishment of mechanisms for program mentoring and regular skills refreshers are associated with retention of clinical knowledge and skill, improved clinical performance, and improved patient outcomes [16, 21]
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