Liberia | Overview
Quality Improvement and Helping Babies Breathe in rural Liberia
Challenge: Liberia had a neonatal mortality rate of 25 per 1,000 live births in 2017, one of the highest in the world. Systems and quality gaps are the major contributors to poor maternal and neonatal outcomes. Understanding quality improvement (QI) strategies can help overcome these gaps.
Where We Started
Boston Children’s Hospital partnered with Partners in Health at a PIH-supported district hospital and health care center to provide neonatal resuscitation training called Helping Babies Breathe. Pediatric and maternity nurses, nursing aides, community health workers, and midwives were taught. Boston Children’s and PIH staff also provided a quality improvement workshops to familiarize staff with the strategies of quality improvement. Mentoring was provided in the pediatric and maternity wards to help strengthen care practices with local nursing staff.
Hands-on training was provided to 32 participants, who all successfully completed the training curriculum. Several quality improvement initiatives were started in the pediatric and maternity wards at J.J. Dossen Hospital in Harper.
The team will continue to provide support to the participants as they develop and implement quality improvement projects as well as continue to support the initiative to develop the NICU at J.J. Dossen Hospital, including providing mentoring to the nursing staff there. Helping Babies Breathe training is currently being expanded to additional district hospitals.
Deb O’Dowd, Global Nursing Fellow
Building a Pediatric Workforce
Liberia is severely understaffed in pediatric medical and nursing care. Currently, the country has more than 2 million children and only 11 pediatricians.
Where We Started
Over the past 12 years, Boston Children's has worked with partners in Liberia to create and implement a pediatric residency training program to generate the only nine Liberian-trained pediatricians. Now that the program is established, the partnership focuses on extending the reach of high-quality pediatrics to other facilities and into the community to support newborn care at clinics and the development of nutrition programs.
Together, Boston Children’s and the Liberian pediatrics department has successfully trained the country’s first nine pediatricians. The partnership has expanded to collaborate with the African Federation for Emergency Medicine to pilot a curriculum for nurses and physicians in pediatric emergency care that will be able to be used all over Africa to train other providers.
Over the next year, nurses from the Boston Children’s Global Health Nursing Fellowship will be working with nurses and midwives in Liberia to implement nurse training curriculums in general pediatric and NICU care, to try to reduce the high neonatal mortality rate both at the hospital and in the referral clinics and health centers.
Michelle Niescierenko, Global Health Program Director and Pediatric Emergency Medicine Attending
Cash to Improve Dietary Diversity: A Cluster Randomized Trial
There are more than 230,000 children in Liberia suffering from chronic malnutrition, and 36 percent of children under the age of 5 are stunted (experiencing impaired growth and development). Inadequate dietary diversity is strongly associated with stunting in children under the age of 2. Interventions to improve dietary diversity are needed to prevent sequelae of stunting, which include impaired development and reduced future economic earnings.
Where We Started
Partnering with UNICEF Liberia, the Liberian Ministry of Health, and the National Public Health Institute of Liberia, the Boston Children's team developed a cluster randomized trial to evaluate the efficacy of a cash transfer and nutrition education program through community health assistants to increase dietary diversity and improve health outcomes among children 6 to 23 months of age in Grand Gedeh County, Liberia.
A multi-pronged interventional package aimed at strengthening the household environment may result in improved dietary diversity for young children. Such programming may serve as a model for governmental and non-governmental organizations working in childhood nutrition in resource-limited settings.
Chris Rees, Pediatric Emergency Medicine and Global Health Fellow; Michelle Niescierenko, Global Health Program Director and Pediatric Emergency Medicine Attending
Saving Healthcare Workers’ Lives in Liberia
The Ebola outbreak in Liberia began in the spring of 2014 and by June 2015 had claimed more than 4,800 lives. Tragically, many frontline health care workers (HCWs) were affected, with over 390 cases and 189 fatalities reported in Liberia. The Ebola outbreak severely strained Liberia’s healthcare system that was still improving post-war. Beginning in the fall of 2014, Dr. Michelle Niescierenko, working with the Academic Consortium Combating Ebola in Liberia (ACCEL) and the Liberian Post Graduate Medical Council (LPGMC), implemented an Emergency Infection Prevention and Control (IPC) training, mentorship, supply, and quality improvement intervention to stop the spread of Ebola. The program acquired Personal Protective Equipment (PPE) and disseminated the gear to health care workers in Liberian governmental hospitals accompanied by training on proper use. The project’s core intervention was the development of teams of Liberian physician and nurse trainers who worked with midwives, water/sanitation technicians, and psychosocial support/social mobilization providers to educate health care workers. The teams used the Liberian Ministry of Health and Social Welfare-endorsed “Keep Safe, Keep Serving” training package to provide education about Ebola safety techniques for health care workers and patients. They also implemented elements of water/sanitation infrastructure improvement, community engagement, and social mobilization. The ACCEL teams delivered the “Keep Safe, Keep Serving” training to more than 2,800 health facility staff at Liberia’s 21 government hospitals. They imparted training, provided a three-month supply of PPE, and conducted water and sanitation quality improvement projects, completing more than $221,000 in water and sanitation infrastructure improvements. Through these interventions the ACCEL emergency IPC teams were able to raise hospital safety scores from an unacceptable 56 percent to a positive 82 percent, supporting the safe operation of Liberian hospitals during the Ebola Outbreak and beyond.