Artikel
Introduction of ETAT+: A capacity building project in the region of Alaotra-Mangoro/Madagascar
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Autoren
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Cynthony Noa
- Faculty of Medicine, University of Mahajanga, Mahajanga, Madagascar
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Herizo H. Rajaobary
- Ministry of Health, Regional Public Health Directorate Alaotra Mangoro, Madagascar
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Miora Miadanaarisoa
- Faculty of Medicine, University of Mahajanga, Mahajanga, Madagascar
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Martina Fier
- Friede Springer endowed professorship for Global Child Health, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Michael Galatsch
- Institute of Nursing, School of Health Science, Zürich University of Applied Science, Winterthur, Switzerland
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Karen Fahlbusch
- Friede Springer endowed professorship for Global Child Health, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Farzana Yasmin
- Friede Springer endowed professorship for Global Child Health, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Todisoa Nomenjanahary Andriatahina
- Société Malgache de Pédiatrie (SOMAPED), Madagascar; Faculté de Médecine, Université d’Antananarivo, Madagascar
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Hans-Jörg Lang
- Friede Springer endowed professorship for Global Child Health, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Diavolana Köcher-Andrianarimanana
- Faculty of Medicine, University of Mahajanga, Mahajanga, Madagascar; Faculté de Médecine, Université d’Antananarivo, Madagascar
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Ralf Weigel
- Friede Springer endowed professorship for Global Child Health, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| Veröffentlicht: | 4. November 2024 |
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Gliederung
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Background: Despite substantial improvement in child health Madagascar faces considerable socio-economic and environmental challenges, impacting child survival. This university partnership focuses on capacity building for essential paediatric emergency and critical care in response to urgent healthcare needs in the region of Alaotra-Mangoro.
Project description: Project plan: Figure 1 [Fig. 1]
Project duration: 01.07.2022–30.06.2024
Partners: CHU Mahajanga, SOMAPED, MOH, UWH.
Project sites: 5 regional/district hospitals and 25 associated health centres.
The training content is based on WHO-ETAT guidelines and international critical care recommendations.
The following activities define the project:
- Workshops were conducted to inform regional health authorities, and community leaders.
- Interprofessional medical training, including an online program, a train-the-trainer (TOT) process, and on-site training, was complemented by the provision of essential biomedical equipment for participating health facilities. Training for health facility technicians was aligned with clinical training.
- Pragmatic health facility assessments were conducted to evaluate preparedness for essential paediatric services.
Results & challenges: Leadership and community workshops facilitated project activities. The TOT approach, with on-site instructor support, aided in disseminating essential competencies. Online trainings were successful in supporting on-site activities. Technical and medical training sessions accompanied introduction of biomedical equipment and strengthened preventive maintenance systems. Feedback from participants and health facility evaluations highlighted challenges in implementing essential paediatric hospital care, including logistic and supply issues such as unreliable electricity impacting O2-concentrator use, and limited availability of essential medication and supplies. Barriers to access health facilities included difficult road conditions in some parts of the region, challenges in transferring patients due to limited ambulance availability and transfer costs. Additionally, challenging road conditions affected transport of essential supplies to remote health facilities.
Discussion: The TOT approach is a valuable project concept. Both online and on-site training proved feasible. Integrated technical and medical sessions, accompanied by the introduction of biomedical equipment, enabled efficient use and maintenance. Geographic and socioeconomic access barriers to essential health services require further evaluation. Identified logistic challenges in health facilities need sustainable solutions.
Conclusion & perspectives: This project enhances capacity and exposes challenges in ETAT/EPECC implementation in a region in Madagascar. Addressing these demands requires collaboration with training institutions, professional societies and MOH. Future project activities can focus on strategies to improve access for vulnerable populations to essential paediatric services.
