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The principle of participation and right to information: an asset for sustainable management

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Involving community leaders more closely in the interventions.

Georges Bonabe
+237697055606
bonabe7@gmail.com

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Data should not just be collected for use above facility level

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Data should not just be collected for use above facility level

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Too many times, health workers are asked to collect data and fill out forms, but they do not get the benefit of using this data. Systems should be developed to help health workers use these data; EMRs with built in decision support can support this

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Commitment and support for quality of care activities.

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Commitment and support for quality of care activities.

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Share with staff, communities, politicians etc the outcome/impact of quality of care 

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Share with staff, communities, politicians etc the outcome/impact of quality of care 

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data use should be part of leadership training so that data can be used for decision making, policies and ensure accountability

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data use should be part of leadership training so that data can be used for decision making, policies and ensure accountability

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Health professionals must include accountability in their performance reviews. this will help them to assess their own work and do self-checks to enhance improvements

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Health professionals must include accountability in their performance reviews. this will help them to assess their own work and do self-checks to enhance improvements

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We need to find ways to respectfully and intentionally parents as partners in all aspect of MNH - including care but also policy development, research and accountability mechanisms. Notably affected parent groups eg preterm, stillbirth

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checklists, process SOPs tracking tools should be clear with follow up and feedback with action taken 

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checklists, process SOPs tracking tools should be clear with follow up and feedback with action taken 

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advocacy for collecting less data, less detail.

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advocacy for collecting less data, less detail.

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Leadership at facility level can already start with point of care QI practices while health system is getting its act together - start with what you have and build upon, rather than waiting endlessly for health system to become fully functional.

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Leadership at facility level can already start with point of care QI practices while health system is getting its act together - start with what you have and build upon, rather than waiting endlessly for health system to become fully functional.

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Promoting Research Driven Policy and Practice

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Promoting Research Driven Policy and Practice

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Involving the academic will promote research driven policy and practice. RMNCH programmes should welcome and include research outcomes in program implementations

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Leadership integrity and decision making transparency

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Leadership integrity and decision making transparency

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Establish dashboards that could be populated by staff and shared with the QI Teams to make decisions

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Establish dashboards that could be populated by staff and shared with the QI Teams to make decisions

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put in quality lenses on what they approve plan, report and budgust

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put in quality lenses on what they approve plan, report and budgust

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Establish an iterative process of inquiry/curiosity without being penalized so health care providers are willing to understand what went wrong, what went right, and how to improve those aspects that were not working.

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Establish an iterative process of inquiry/curiosity without being penalized so health care providers are willing to understand what went wrong, what went right, and how to improve those aspects that were not working.

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Breaking the barrier between healthcare professions

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Breaking the barrier between healthcare professions

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The existing barrier between the different cadre of healthcare professionals should be removed, promoting teamwork and synergy in provision of MN care

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A Chief Midwifery officer for every country. 

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A Chief Midwifery officer for every country. 

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Ensure resources are available for personnel to conduct their job

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Ensure resources are available for personnel to conduct their job

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Strategic decision making with quality as a priority to align resources 

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Strategic decision making with quality as a priority to align resources 

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Accountability and responsibility is key to any program or day to day activity. If  a  healthcare provider  is accountable/ responsible  he/she will do the best. At the same time community also needs to be responsible.

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Accountability and responsibility is key to any program or day to day activity. If  a  healthcare provider  is accountable/ responsible  he/she will do the best. At the same time community also needs to be responsible.

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Be present as a leader, establish quality benchmarks

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Be present as a leader, establish quality benchmarks

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Roles and responsibilities for each level and demarcation between different roles

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Clearly defined goals and targets,  clearly marked timeline, with assured funding, and popular support for the activity

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Develop a clear learning process to examine the effectiveness of new interventions.

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Ensure midwifery students are educated by midwifery academics and clinicians to ensure they are taught within a midwifery model of woman centred care.  

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Ensure midwifery students are educated by midwifery academics and clinicians to ensure they are taught within a midwifery model of woman centred care.  

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Educate prenatal moms - what to expect when expecting and delivering

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Educate prenatal moms - what to expect when expecting and delivering

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Develop quality guidance, checklists, auditing tools in areas related to IPC, triage system, referral system, documentation and reporting, clinical management standards, infrastructure , etc and how supportive supervision supporting the implementation of these tools

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Mentors, leaders and health providers all need to know their responsibilities and should be accountable- but equally important is the culture of nurture and appreciation

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Mentors, leaders and health providers all need to know their responsibilities and should be accountable- but equally important is the culture of nurture and appreciation

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Include women and those who are impacted by decisions, in the decision-making. Ensure that women are listened to and inform decisions.

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Hybrid, blend of directed and self-directed learning, respecting adult learners

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Hybrid, blend of directed and self-directed learning, respecting adult learners

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Embedding research at primary care level for learning, testing and refining of solutions that are contextually relevant and suitable. An embedded approach means learning is continual and applied to health systems strengthening problems for that context.

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Better facility structures welcoming to mothers

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Better facility structures welcoming to mothers

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On-going and supportive mentorship- blamefree, constructive and respectful learning environment for frontline workers

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On-going and supportive mentorship- blamefree, constructive and respectful learning environment for frontline workers

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Integrate IR /development monitoring/evaluation to inform programming. 

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Integrate IR /development monitoring/evaluation to inform programming. 

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Implement participatory research to learn from the community before engaging them

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Implement participatory research to learn from the community before engaging them

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while health systems require a blame free environment to work, it is critical that there are opportunities to hold individuals and institutions accountability for failures and negligence- how can this work i.e. hold people accountable while maintaining a no-blame culture

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Leadership makes all the difference,  one good leader can change the services, management and the quality of care.

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Leadership makes all the difference,  one good leader can change the services, management and the quality of care.

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Bring all relevant parties together to join hands and plan (+ prioritize + leverage resources), implement, monitor/evaluate) together.

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Bring all relevant parties together to join hands and plan (+ prioritize + leverage resources), implement, monitor/evaluate) together.

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Tracking what is done and reporting back to teams on actions motivates and encourages more action

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Engaging communities in  accountability for quality 

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Engaging communities in  accountability for quality 

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increasing community/patient voices in MPDSR particularly in unpacking the 3rd delay and how the 3rd delay contributes to mortality.
How can MPDSR harness the voices of the affected communities to improve QOC

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Innovate on self care and community based care

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Innovate on self care and community based care

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Systems to explore and adapt to self-care and community based care where possible to expand care and maintain quality even as facility services are disrupted by crises

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Clear national and district level leadership trainings for ministry of health managers in how to plan and resourcing MNH services

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Il faut inclure une ligne budgetaire pour la qualité de la des soins

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Local solutions from local communities  

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Local solutions from local communities  

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Clients should have the power to seek accountability 

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Clients should have the power to seek accountability 

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Ensure care according to needs of sub-populations

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Ensure care according to needs of sub-populations

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Ensure that the system serves different sub-populations affected by crises adequately. Not clumping all mothers and newborns as one homogenous group, but understanding how crises exarcebate vulnerabilities for subpopulations of this group, necessitating an equity lens that is also intersectional lens.

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Competency based training is essential along with mentoring and coaching 

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Competency based training is essential along with mentoring and coaching 

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Strengthening leadership and management overall (not specific but inclusive of MNH) at facility and subnational levels to enable a healthy organizational culture conducive to learning, innovation and accountability

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Advocate for action on the broader determinants of health -- economic, social, environmental and beyond -- to improve the baseline health status of all.

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peer-peer and collaborative learning is important to practice QI

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peer-peer and collaborative learning is important to practice QI

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The Health care providers supported for ongoing training and maintaining of key knowledge, skill  and comptency 

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The Health care providers supported for ongoing training and maintaining of key knowledge, skill  and comptency 

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Development and implementation of health security, emergencies and resilience plans that better address MNCH 

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Development and implementation of health security, emergencies and resilience plans that better address MNCH 

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RMC as discussed yesterday should be emphasized across the board with emhasis on patients care as well as suppot to Health Care workers

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RMC as discussed yesterday should be emphasized across the board with emhasis on patients care as well as suppot to Health Care workers

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Give clear guidelines. Good communication between leaders and service delivery

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Give clear guidelines. Good communication between leaders and service delivery

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Quality Leadership informed by all levels starting at community level 

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Quality Leadership informed by all levels starting at community level 

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Have specialised cadres. e.g. midwife instead of nurse/midwife; neonatal nurse, neonatologist

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Have specialised cadres. e.g. midwife instead of nurse/midwife; neonatal nurse, neonatologist

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Case study and hands on practical training

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Case study and hands on practical training

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Facilitate opportunties for communities not just to hear and receive health education but to influence decision making with regard to QOC- how can community voices be included on improving service delivery models

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leadership is needed at all levels of the health system

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leadership is needed at all levels of the health system

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Leadership must be supported to develop the competencies necessary to lead QI at various levels, including supporting competencies such as project management etc. 

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Leadership must be supported to develop the competencies necessary to lead QI at various levels, including supporting competencies such as project management etc. 

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Make sure newborn care is included in pre-service training in adequate depth

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Make sure newborn care is included in pre-service training in adequate depth

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Prioritizing adequate and fairly compensated human resources

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Prioritizing adequate and fairly compensated human resources

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working with leadership as leaders of the changes in Health Syste strengthening is essential

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working with leadership as leaders of the changes in Health Syste strengthening is essential

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Flexible capacity building approaches that can be in-person, remote or hybrid.

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Flexible capacity building approaches that can be in-person, remote or hybrid.

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adequate supervision and support for frontline providers

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adequate supervision and support for frontline providers

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Quality improvement initiatives including maternal and perinatal death surveillance and response (MPDSR)

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Quality improvement initiatives including maternal and perinatal death surveillance and response (MPDSR)

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notre responsabilité est d'intégrer la formation sur les interventions à haut impact de la santé de la mère et du NN et les soins post grossesse et planification familiale en post partum par le biais de renforcement de capacité des prestataires et introduction du processus d'amélioration de la qualité pour résoudre leurs propres problèmes 

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notre responsabilité est d'intégrer la formation sur les interventions à haut impact de la santé de la mère et du NN et les soins post grossesse et planification familiale en post partum par le biais de renforcement de capacité des prestataires et introduction du processus d'amélioration de la qualité pour résoudre leurs propres problèmes 

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nous formons les prestataires en santé maternelle et néonatale sur les soins maternels et néonatale autour du jour de la naissance selon l'approche PDHF couplée à l'amélioration de la qualité