Jubilee information

Concept Note: Building a modern pediatric ward and Neonatal ICU at Selian Lutheran Regional Referral Hospital

Dr. Amon Israel Marti, MD, MMed,

amonisarel@gmail.com

Children care in the hospital setting has its unique complexity depending on pre and after birth conditions. There are children born too small to maintain their body temperature, some born as preterm, others born with disabilities while some just appear to be clinically unhealthy. Some children become infected after leaving the health facilities for parents’ home care. The newborns are highly at risk of infections due to the fact that their immune systems are still in the development stage. In general handling of these children differs depending on their ages and conditions. The clinical staff needed to address children healthy challenges also are not from anyone field but a combination of the care health staff. Some require pediatricians, others physiotherapists while other children need care by surgeons at their early days. There are also no general wards for children that serve them well but classified environments fitting each particular child and his or her conditions. The preterm babies require incubation and a great care from both their mothers and clinical staff.

Background and the Context

A neonate is a baby who is four weeks old or younger. The baby is also called newborn. Generally, the first 4 weeks of a child life is referred to as a neonatal period. It is the time characterized with a rapid change and several critical events can occur in this period.

• Establishing feeding patterns
• Bonding between parents and infant begin.
• The risks for infections that may become more serious are higher.
• Many birth or congenital defects are first noted.

According to UNCEF Data Warehouse (2021), Neonatal mortality rate in Tanzania stands at 20 per 1,000 live births. The similar rate for infant is 34 per 1000 live births. It is also documented that in 2021 a total of 47 under five children died per 1,000 live births due different causes. This information indicates that a lot is to be done to ensure child well-being. UNICEF uses human rights approach to pursue a vision of realizing the rights of every child, including the right to life and has a call “leave no child behind” with a goal to fulfill the rights of every child, everywhere.

UNICEF as an organ of the UN has programs to achieve 45 child-related Sustainable Development Goals (SDGs). The organ evaluates on a regular basis the performance of each country and establishes how much additional effort might be required to achieve the child-related SDG targets.

Selian Lutheran Hospital efforts to improve care to children aims to achieve global and national targets under the child-related SDGs. Currently; the hospital has pediatric ward and neonatal ICU unit located at different buildings. The neonatal ICU, built within the Obstetric ward takes care of children at critical healthy conditions and the preterm newborns. Its current capacity is 10 neonates. The general pediatric ward is developed within the general medical ward. The medical ward accommodates male adults, female adults and children sub wards.

Why we need a separate pediatric and neonatal ICU building

Selian Lutheran hospital has a strong and competent pediatric team. There are two pediatricians and well trained nursing staff working together to provide care for children. The hospital has also benefited from international volunteers whose presence enables modeling the best practices and delivers specialized on job training. The gap comes from work environments; the pediatric ward and the NICU are merged within other wards posing the challenges in healthy management for the newborn and the children under five. In addition, as a Regional Referral Hospital, Selian hospital intends to increase the number of inward referrals from private and government owned facilities

Objectives:

The general objective is to contribute to global and national strategies towards ending preventable deaths of newborns and children under-5

Specifically Selian Lutheran Hospital aims at;

1. Establishing maximum care for the newborns by implementing a Kangaroo method
2. Strengthening the bonding between newborns and their mothers by creating enough space for mothers close to their neonates
3. Reducing possible cross infections through availability of enough space between beds in the pediatric wards
4. Increasing the capacity of the Neonatal ICU by creating more spaces and delivering additional equipment
5. Increasing the delivery capacity for pregnant mothers by receiving more referrals from remote dispensaries both government and private owned

Activities and Methodology

The primary activity of this project is to build a state of the art pediatric ward and neonatal ICU under one roof at Selian Lutheran Hospital. The processes will include: Finding the funding partner by way of sharing this concept note, recruiting and engaging with the building contractor through a competitive tendering process, Monitoring and supervising the construction works on a day to day and regular basis and reporting to the donors. The secondary activity will be purchasing equipment for neonates and children healthy management. The hospital needs 30 incubators, 15 baby warmers, 10 infusion pumps, 30 ICU monitors, 10 Neonatal ventilators and 1 phototherapy machine

Targeted beneficiaries and how they are going to benefit from the project

The neonatal ICU and pediatric ward building will benefit different groups of people, either directly or indirectly.

Direct beneficiary: The neonates and children are the direct beneficiaries of this project as the hospital aims at reducing deaths and improving their wellbeing. It is expected that completion of the building will improve care and environment at which children are treated in the hospital. The project is expected to increase delivery and the Neonatal ICU capacity of the hospital. Mothers at the neonatal ICU will have space close to their children at incubation therefore increasing baby-mother bonding.

Indirect beneficiaries: These include clinical staff at the pediatric and neonatal ICU wards that will have conducive work environment. The project will motivate a team of around 20 staff taking care of the children in the pediatric ward

Project actors

The main project actor is Selian Lutheran Hospital management. Their role will be to monitor and supervise the building works to ensure the works meet standards and the intended goal. The government of Tanzania through Ministry of Health will provide guidance and supervise provision of health services in the pediatric ward. The development partners are expected to provide financial supports for the construction works and procurement of the proposed equipment

Expected outcome and impact:

It is expected that pediatric and neonatal ICU ward will provide the following outcome;

• Number of deliveries raised up to 120 children per month
• Adequate space between one incubator (or bed) and another thus reducing possible cross infection
• Availability of enough space for mothers to stay while their children are at incubations
• Practicing kangaroo method of care between mothers and their newborns
• Improved management of the children in treatment at the wards
• Accommodating 30 neonate at time at NICU
• Advocating Selian Lutheran Hospital services to the general public
• Increased partnership among Selian Lutheran Hospital, development partners and the Government of Tanzania

Monitoring and Supervision:

Supervisory roles: Hospital Management Team will recruit the contractor and supervise the construction works. The project will have one coordinator who will monitor day to day activities and will provider updates to the hospital secretary and the Hospital Director. Implementation of this project will also be supervised on a regular basis by the hospital Board of Directors and the management of the ELCT North Central Diocese which is the legal owner of the hospital.

Reporting: The hospital will maintain both financial and activity records as a good practice. The hospital will prepare and submit interim and final narrative reports to the funder as part of accountability to the donors. These reports will include photos, graphs and financial summary as appropriate

BUDGET AND RESOURSES:

The initial Bills of Quantity indicates that building the three storey Neonatal and Pediatric ward at Seklian Lutheran Hospital will cost Tanzania Shillings 779,910,213.00 (Bills and Quantity Survey attached). This amount will be raised from Selian Lutheran Hospital Development partners.