Healthy Women/Healthy Babies/Alwayscare.

Attaining the MGDs, 4 and 5 is not an easy task especially in lower and lower middle income countries like Cameroon. crippled with poverty and  socio-political crisis in the anglophone regions, most women and children have no access to health facilities. Therefore increasing the maternal/ newborn morbidity and mortality.

 In rural areas, 36 deaths per 1,000 live births. Among the poorest households is 39 neonatal deaths per 1,000 live births, and maternal mortality ratio is 596 per 100,000 live births. (UNICEF-2019)

Our purpose is introducing a hook and spokes model that will be capacitating the local birth attendance, community health workers, nurses/midwifes, and doctors and forming a strong link of managing and referring any difficult situation to the next higher and competent structure. This is going to reduce the maternal/newborn deaths and diseases. 

This model is to be tested in a rural district in the anglophone (crisis) region  of Cameroon.

According to 2019 UNICEF report, 861,000 babies in 2017 that is about 2,400 babies per day in Cameroon. Approximately 56 babies will die each day before reaching their first month; 45 stillbirths occur every day. Cameroon’s neonatal mortality rate is 24 deaths per 1,000 live births.

In rural areas is 36 deaths per 1,000 live births and 25 deaths per 1,000 live births in urban areas. Among the poorest households is 39 neonatal deaths per 1,000 live births, compared to 29 deaths per 1,000 live births among the richest households.The maternal mortality ratio is 596 per 100,000 live births. 

The skilled health professional density is 6 per 10,000 population with a physician density of 0.1 per 1,000 population and nurse/midwife density of 0.5 per 1,000.

For the past three years the two anglophone regions of Cameroon have been facing some political crisis with more than 3,000 deaths, 50,000 refugees in neighbouring Nigeria and about 200,000 internally displaced either to the neighbouring regions or same regions to the bushes and camps for safety with no health infrastructures. This situation worsens the health of both pregnant women and children, and thus increases maternal and child morbidity and mortality.

The  "Hook and Spokes model" that links the local birth attendance to the higher institutions. 

This will entail from the top identifying the health structures that are at the  district, selecting some midwifes/nurses and doctors and training them as trainers on management of pregnancy and newborn related complications using the Advance life support in obstetrics guidelines and helping babies breath guidelines. 

Cameroon's health system consists of 5 levels;  general hospitals,  central Hospitals, regional hospitals, district hospitals, health centres

The trained nurses/midwifes and doctors will then descend to the various health centres to train the identified local birth attendants and selected community health workers (CHW). The senior trainers oversee the work is done and continues follow-up is done.

A health centre covers several villages (10-20) and each village has at least 2-3 local birth attendance who assist the women during delivery. 

In this model, the trained birth attendances and CHW will work in collaboration in the villages. Tool kits will be given to birth attendance that will be used for safe delivery and also provide medications (iron supplements and fancida for malaria for prevention). there shall be a relay of information from the CHW to the health centre and or district.

The model is targeting the rural areas with Kumba district being a pilot for the study. Kumba is found in the southwest region of Cameroon with a population of about 900,000 inhabitants. It is one of the most hit areas by the anglophone crisis. There is a district hospital that has 2 gynaecologists and these are the only 2 gynaecologists that serve the above figured population and it environs. There has no paediatrician serving this population and I am the only visiting paediatrician who comes to the place every weekend. I have been a visiting paediatrician there now for about a year and have seen the plight of the people. health centres and other neighbouring health structures that used to serve the population have been burned down by the crisis and others deserted. Most people live the bushes and camps. No antenatal visits during pregnancy deliveries are conducted by local women in their communities. Most poorly done, complicated situations not referred or followed-up. Thus the training of these local birth attendances and community workers, provision of tool kits,and creating a chain of supervision and continuous follow-up by the trainers/ senior trainers will go a long way to bridge this gap.

As a population that is underserved in terms of facilities like health infrastructures and being very poor, capacitating them and sort of including them in the chain of health care providers with proper monitoring and evaluation, will go a long way to reduce maternal/child morbidity and mortality thus helping to attain the MDGs 4 and 5

There has always been the training of local birth attendances, and also the training of midwives/nurses and doctors. In this model, we are encoperating the helping babies breath, community health workers, the provision of tool kits and medications for prevention of malaria, anaemia and congenital neural defects by providing iron and folic acid. Moreover the creation hook and spoke that deals with monitoring and evaluation of what is going on at the level of the villages and which gets directly to the trainers and senior trainer through assessment using a semi structured questionnaire that has been programmed on an android smart phone using Open Data Kit (ODK) connects applications to capture the information towards safe childbirth.

This data is collected by the CHW for every delivery and stored. when ever he is connected, this information is transferred to the data base and thus proper follow-up is done in the community. With this model much data will be generated from the community and with proper monitoring and evaluation, better results will be generated.

The core technology incorporated in our model is the Open Data Kit which will help us in generating community data, transferring the data to our main server and this can be transferred to the DHIS2 which is being used by the ministry of health at the level of the district.

Open data kit is a free app from the pastor that has been existing for some time now and it is always used by researchers to collect data at the community level. Here below is a demo of open data kit we shall train the community health worker to use with our semi structured questionnaire.

We have developed a hook and spokes model for the maternal and newborn health that involves specialists doctors, general practice doctors, nurses/midwives, community health workers and local birth attendances.

This will involve a chain of training by beginning with the training of trainers by specialists doctors who will train the general practice doctors and nurses/midwives on obstetrical care and neonatal care using the advanced life support in obstetrics guidelines and helping babies breath guide lines reactively. These trainers will then be the ones to get to the local levels with at least a senior trainer to train the chief of post at the health and the local birth attendances and CHW. After the training tool kits to assist them during their day to day practice will be given to them including medications for the prevention of malaria and anaemia and congenital neural tube defects (Fancida and iron/folic acid). 

The the phone of every community health worker will be incorporated an application called Open Data kit which will contain a semi structured questionnaire for the follow-up of child birth. This same questionnaire will be found at the level of hospital to take down information of received pregnant women and or their newborns. The referral system will be followed up closely and what has been done at every level. It should be noted that basic resuscitation materials will be provided to assist in both mothers and helping the babies breath. 

It should be noted that a baseline study will be carried out at the level of the hospitals to understand the ground situation. After the training, there will be a follow-up evaluation during the first month to see if the data collection methods are correct. There will be a second evaluation 3 months later to see the impact and lastly an outcome evaluation 3 months later. 

After the final results generated and analysed, we shall the evaluate our pilot and prepare to reproduce it elsewhere.

My solution is still in the making but the pilot will be serving a population of almost a million which is going to be within a yeah. In the next 5 years I wish to cover all rural areas of Cameroon and even the neighbouring countries like Central Africa and Chad. This means more than 30, million people in the next 5 years

My solution is still in the making but the pilot will be serving a population of almost a million which is going to be within a yeah. In the next 5 years I wish to cover all rural areas of Cameroon and even the neighbouring countries like Central Africa and Chad. Helping infants survive and thrive will definitely be incorporated in our objective to make sure no child is left behind in our model.

1) Since we are dealing with a large population and also involving capacitation and provision of products, our greatest obstacle will be financial. 

2) We also face challenges of political unrest. Some areas are very difficult to reach due to militia that are found there. 

1) This financial burden can be reduced a bit if we succeed in having a health facility that will help take care of the mothers and children at very low cost and at the same time help us generate some income that will help us expand our dreams.

2) A partnership with doctors without borders will be created to help us as far as transportation is concern as they are reputed for reaching every end.

We are not having any full time nor part time staffs. everybody in the team is a volunteer.

My team is made up of Experts in the field of maternal and child health 

Dr. Esuh Esong Lucas is a Paediatrician/neonatologist and a public health physician .

Pr. Mah Evelyne is a senior lecturer in the faculty of medicines and Biomedical Sciences in the University of Yaounde I, she is a paediatrician neonatologist.

Dr Eposse Charlotte is also a Paediatrician and faculty member in the Faculty of Medicines and Pharmaceutical Sciences in University of Douala

Dr Enongene Paul Ngang is a Gynaecologist and director of the Kumba district hospital

Dr Assonganyi Etienne is a Gynaecologist and medical adviser in Kumba district hospital

Dr Wandji Bridget is a Gynaecologist  in Yaounde Central Hospital

Dr Tanyi Mpeh Brenda is of general practice and certified trainer in advanced life support in obstetrics.

This team if the senior trainers team that is going to be training the trainers.

I am currently partnering with The pollination Project in Berkeley in reducing covid 19 in Bangem rural Cameroon

We intend to sustain financially by open health structures that will help rain some income to better serve the population

With the Wonderfull dream of helping the underserved and owing to the fact that these people are in dying need, I come to as a wonderful structure that can help me achieve this goals. much shall I get from coaching mentoring and even financial not to name the least.

I would like to partner with solve in order for my dreams of helping the needy grow bigger and bigger. 

I would like to partner with all listed here because they are dealing with women, children, underserved

This is because I am dealing with a population that is undergoing crisis. some leave in the bushes others in camps. The internally displaced.

This model in enhancing and capacitating local women on safe childbirth and also helping mother to give birth safely.

We are capacitating the health worker and introducing new health workers in to the system that is CHW and local birth attendances.

It is a model that is enhancing the lives of women and children thus enhancin humanity

We are involved in achieving the MDGs 4&5 and this is the dream of the BILl and Melinda Gates. Working together will make this Wonderfull dream come true

I strongly think my team has the brightest minds as concerns maternal and child health. we have been serving the rural communities for some time and we wish to to more. with this partnership we can go further.