South Sudan: Health eVillages Technology in Healthcare Program

Maternal Near-Miss Audit Conducted: July – October 2015

November 13, 2015

Dr. Taban Martin Vitale

Project Goal:

  • The overall goal of this project is to ensure high quality healthcare service delivery with specific focus on maternal child health to reduce maternal and child mortality in Juba Teaching Hospital and the country of South Sudan
  • To familiarize staff at the only national referral and teaching hospital in South Sudan with and to train on digital reference, data collection, and decision support tools
  • To get an accurate estimate of the scope and cost for building a Center of Excellence in Juba
  • To get an accurate estimate of maternal morbidity and mortality in Juba Teaching Hospital which presumably represents the most high-risk obstetric cases in Central Equatoria

Project Objectives during this reporting period:

  • To build the capacity and support the target healthcare professionals in the use of HeV’s preloaded tablets
  • To encourage healthcare professionals to apply evidence based medicine with the help of mobile tablets with Health eVillages suite and available internet services to provide quality healthcare
  • To refurbish the ANC unit at Juba Teaching Hospital making it more conducive for patients and healthcare workers
  • To continue Maternal Near-Miss Audit in Juba Teaching Hospital and use the outcome of the survey to improve maternal care in Juba and all of South Sudan
  • Ongoing support of all health workers in Respectful Health Care
  • Improved Data Tracking in Maternal Mortality
  • Improved Service Delivery and Patient Satisfaction

Summary of RMF/HeV-sponsored activities carried out during the reporting period under each project objective:

  • Conducted Maternal Near-Miss Audit for Juba Teaching Hospital, completed both quantitative and qualitative data collection successfully; data analysis is ongoing
  • Improvement of infrastructure of Antenatal Care Unit of Juba Teaching Hospital to make it more conducive for mothers/patients and healthcare professionals, work is still ongoing
  • Continued mentorship of the nurses/midwives on the proper usage of HeV’s tablets preloaded with medical information
  • Continued evaluation of the impact of the HeV tablets through monthly collection of information and data, using the health worker survey and patient satisfaction form, designed for this purpose
  • Conducted meetings to share experiences, both positive and shortcomings in use of the HeV tablets, and discussed and brainstormed how to overcome the challenges
  • Continued support of high WIFI internet services in the Maternity Unit
  • Continued implementation of RMF’s Respectful Maternity Care approach

Results and/or accomplishments achieved during this reporting period:

  • The ongoing work in the infrastructural improvement of the ANC department is changing the face of the maternity department and positively influencing the healthcare workers to ensure respectful healthcare and patient centered service delivery.
  • 1,022 quantitative data collected and entered accurately using SPSS software and now analysis is ongoing as part of the Maternal Near-Miss Audit in Juba Teaching Hospital.
  • 32 qualitative data collected (interviews) in local Arabic and the audio of all the 32 interviews translated and transcribed into a word document in English, and awaiting analysis.
  • The trained Maternal Near-Miss supervisors and the data collectors have improved the quality of data collection in the entire Obstetrics and Gynecology department as all of them are still serving in this department.
  • The JCONAM midwifery students who participated in the Maternal Near-Miss data collection have now gained some experience in research, especially in the areas of data collection.
  • The final analysis of the Maternal Near-Miss Audit is ongoing and the report will be produced at the end of the analysis which will guide our intervention in improving maternal care in Juba and all of South Sudan.
  • The nurses/midwives, doctors and consultants continued to benefit from the internet services provided in the maternity unit hence improving quality of service delivery, since they are able to get to do reference checks.
  • The two national tutors at Juba College of Nursing and Midwifery are able to do quick reference checks during lectures and supervision of the students in clinical practice with the help of HeV tablets.
  • The healthcare professionals are able to provide evidence based medical care for patients as 63% of them reported using the tablets to aid their work almost daily and 37% used the tablet 3- 5 times a week as reported in the month of October 2015.
  • There was also 100% usage of the tablets by the healthcare workers in the areas of disease diagnosis, reference to drugs and videos.
  • Out of 20 patient satisfaction forms completed in the month of October, 5 reported that the healthcare workers were using the tablets during the care provided to them while 15 said the healthcare workers were not using the tablets during the medical services provided to them. The low usage of the tablets at the patient bed side could be due to high patient inflow and turnover such that the healthcare workers may not have enough time to spend on one patient as the number of trained healthcare professional in South Sudan is extremely limited. Also not all the healthcare workers in the unit have the devices as the proportion of the healthcare workers provided with the tablets is below 25%. The patients interviewed were also picked at random without clear designed selection criteria hence this might have also contributed to the result obtained.

Notable project challenges and obstacles:

  • Power instability in Juba Teaching Hospital which interferes with internet services as the healthcare workers are not able to access internet services and charge their tablets whenever power is off.
  • High rate of patient flow together with limited number of trained healthcare workers making it very difficult for the available healthcare workers to use the tablets while on duty
  • Healthcare workers in Pediatrics are not able to access the internet services installed in the maternity block due to wider proximity between the two departments.

Plans for next reporting period:

  • To complete the ANC infrastructure improvement work
  • To consider furnishing the ANC unit after completion of renovation work
  • To implement collaborative antenatal care service
  • To complete the Maternal Near-Miss Audit data analysis and produce final report which will be used to improve maternal care in Juba and all of South Sudan
  • To continue evaluating the impact of the HeV tablets through monthly completion of healthcare worker survey and patient satisfaction forms
  • To consider getting more tablets so as to increase the coverage
  • To consider extending the internet services at the maternity department for another year as the paid subscription will end in January 2016.

(L to R): Nurses/midwives and master trainers sharing their experiences on the usage of HeV tablets; Amani a nurse in Paediatric emergency educating a child on importance of usage of mosquito nets

(L to R): Joyce a nurse in Paediatrics educating the mother of a malnourished child on nutrition; Regina a midwife explaining to a mother how to take the provided medicines after normal delivery; Jackline a registered nurse counselling a mother who has just delivered a baby with congenital anomalies

(L to R): Judith the in-charge of the Maternity unit counselling a mother who underwent C/S due to obstructed labour; Alisa a nurse educating a woman on danger signs in pregnancy during routine antenatal visit; Jackline a nurse managing a woman with head injury with the help of an HeV tablet

(L to R): Joice the in-charge of the ANC department using the HeV tablet as a guide during lunch break; Fekadu the lead investigator for the Maternal Near-Miss Audit conducting training for the team before data collection; Maternal Near-Miss Audit team during the orientation workshop

(L to R): Maternal Near-Miss Audit training in progress; Maternal Near-Miss Supervisors evaluating the progress on data collection

(L to R): Maternal Near-Miss Supervisors evaluating the progress on data collection; Annet, a midwife, confirming the number of completed quantitative data; Maternal Near-Miss Supervisors chatting with the JCONAM midwifery students helping in quantitative data collection

(L to R): Keri (L), RMF logistics coordinator, discussing with Fred contracted to refurbish the ANC unit; Judith (R), JCONAM midwifery tutor, with the contractor at the ANC Unit; Contractor delivering construction materials at ANC

(L to R): Contractor delivering construction materials at ANC; Contractor creating an extension to be used at waiting area for mothers attending ANC services

(L to R): Shielding the proposed waiting area by welding burglar proof materials; Former waiting area to be partitioned into HIV counselling area and dispensing room for ANC

(L to R): Painting in progress; AC installed and an additional small room for dispensing drugs; Three examination rooms created inside the ANC block



In addition to funding for a full-time physician, Health eVillages, which provides iPods®, iPads® and other handheld devices equipped with specialized references and clinical decision support tools to medical professionals, will deliver 30-50 mobile devices pre-loaded with clinical content each year to nursing graduates. Having this best-practice clinical information available at the point of care will help overtaxed medical personnel deliver high-quality patient care as effectively as possible in a challenging clinical environment.