Dr. Innocent Harbert Nkonwa

Dr. Innocent Harbert Nkonwa

MMED, MBCHB (MUST), MPHL, Field Epidemiology Fellow (UPHFP)
Email: nkonwai@musph.ac.ug nkonwai@yahoo.com
Tel: +256772342202

Host Site: Reproductive Health Division, Ministry of Health

Host Mentors: Dr. Blandina Nakiganda and Dr Makanga Livingstone

ABOUT THE FELLOW

Dr. Innocent H Nkonwa, is a graduate holder of Master of Medicine (Obstetrics and Gynecology) and Master of Public Health Leadership from Uganda Christian University. Prior to joining the program, he was the Medical Director of St Charles Lwanga Buikwe Hospital and also in charge of Katikamu South Health Sub District Luwero District. While on the program, Innocent was hosted at Reproductive Health Division within the Community Health Department.

Achievements at the Host Site

While at the host site, Innocent was involved in the Emergency Obstetric and Neonatal care activities

• Assessed current system of data collection for maternal mortality and provided recommendations to improve and expand surveillance coverage, at the community and facility levels.
• Analyzed HMIS data on key RHMNH outcomes and recommended ways to ensure improved reporting and data usage.
• Assessed functionality of community-based tracking system to identify pregnancies and deaths. Provided recommendations on how to improve community-based tracking.
• Provided technical support to the Maternal and child mortality surveillance desk including compilation of the annual MPDR report
• Participated in the National orientation of Health workers on the BABIES MATRIX
• Participated as a resource person on RHD led events including Workshops, Conferences and International days.
• Participated in Maternal and Prenatal Death Surviellance and Response training Bududa District
• RBF assessment for Kampala, Sironko and Mityana districts
• Facilitated in the RBF orientation of Buikwe,Kampala,Wakiso,Masindi,Kole,Amolator
• Participation in the annual maternal and prenatal death surveillance report
• Trained health workers on result based financing in Kampala, Buikwe and Luwero

Program-specific achievements

The Field Epidemiology training is what I describe as ‘bringing epidemiology to life!’ It has been an exciting and challenging journey where I got a number of achievements. I was able to achieve all the key deliverables.

Emergence Response

• Lead investigator:
  – Marburg outbreak in Kween District, 2018
  – Suspected Meningitis in Mukono District, February 2018
  – Cassava Floor poisoning in Kasese, January 2018
  – Evaluation of Disease surveillance system in Adjuman District, April 2017
• Participated in;
  – Measles outbreak response in Kampala and Wakiso
  – Cholera outbreak in Nebbi District
  – Methanol poisoning investigation
  – Rift Valley fever outbreak in Buikwe, Mityana, Kiboga and Kiruhura

Public health Surveillance

– Improving identification and Management of Hypertensive disorder in Pregnancy, labour and puerperium in Bududa Hospital October 2017
– Descriptive analysis on trends and Aetiologies of Maternal death in Uganda from 2012 to 2016
– Bacteriologic Sputum Non-conversion among TB /HIV co-infected Smear Positive patients in Luwero District, Uganda.
– Participated in data analysis and writing of the National Annual Health Performance report 2017/18
– Participated in data analysis and writing of the National Annual Maternal and Prenatal Death Surveillance and Response report 2017

Leadership and Management
1. National Trainer for Integrated Disease Surveillance and Response
2. National Trainer for MPDSR and Result Based Financing

Scientific Communication
Abstracts and Manuscripts
1. Using Quality Improvement Approaches to improve Maternal and Neonatal death Surveillance in Luwero District Health Centers, Uganda 2018
2. Investigation of Cassava Flour Poisoning Outbreak in Kasese District, January 2018
3. Rift Valley Fever Outbreak: western and central Uganda, October 2017- January 2018

4. Evaluation of the Disease Surveillance System in Adjumani District Refugee Settlements, Uganda, April 2017
5. Bacteriologic Sputum Non-conversion among TB /HIV co-infected Smear Positive patients in Luwero District, Uganda.
Presented at
1. Joint Annual Scientific conference, Uganda
2. International Conference for emerging Infectious Diseases, Atlanta-Georgia, USA
3. Uganda National Field Epidemiology Conference

Summary of Epidemiological Study: 

 Title: Using Quality Improvement Approaches to improve Maternal and Neonatal death Surveillance in Luwero District Health Centers, Uganda 2018

Introduction:  Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) services are an essential component of maternal and child health care. When failures or inadequacies exist in CEmONC systems, poor outcomes such as high rates of maternal mortality and fresh stillbirth tend to persist. Currently, an alarmingly high number of stillbirths, 40,000 per year, occur in the Republic of Uganda. Maternal mortality ratio has slowly declined from 506 to 336 maternal deaths per 100,000 live births while neonatal mortality rate has almost stagnated at 29 per 1000 live births (UDHS 2016). Maternal and prenatal death surveillance and review is important in reduction of maternal and prenatal death
Objectives: To increase the maternal and prenatal death audits done in Luwero District and to improve maternal and prenatal death notification of the done audits to MoH.

Methods:  We reviewed, abstracted and summarized data to identify gaps in delayed identification and reporting of both maternal and prenatal deaths. Health workers in maternity had knowledge gaps in administering treatment in maternal and prenatal audits. We conducted a problem outcome analysis using the root cause method and prioritized the possible interventions to the identified problems basing on their impact value for the patient outcome, is the proposed change under control of the team, is it easy to do, and what resources are required to implement it. We used the Plan Do Study and Act (PDSA) approach to set objectives, indicators, targets, activities, assign tasks and executed the plan. We observed the effect of implementation which is increased auditing and reporting of maternal. We shared progress in weekly and monthly QI meetings.

Results: From April 2018 to June 2018, auditing of the maternal death increased from 0% for maternal audits to 100% at the end of June. Prenatal deaths audits increased from 0% before April to 100% by end of June. MPDSR committee was functionalized at the facilities visited and the district level.

Conclusion: Functionalizing the MPDSR committee and Capacity building for health providers improved the MPDSR process in Luwero District. Use of data through reviews, display and analysis helped to track progress. We recommend adoption of the QI methodology used to improve service delivery in other sectors in the district. The model and lessons learnt, could be used to implement and spread the strategy to improve maternal health services in Luwero District and beyond.

Lessons Learned and skills acquired

1. Conducting outbreak investigations
2. Establishment and strengthening of surveillance systems for both communicable and non-communicable diseases
3. Analyzing both surveillance and secondary data
4. Conducting Quality improvement projects

5. Building partnerships and collaboration with other agencies
6. Capacity building of health workforce
7. Communication and presentation in both national and international audiences

Next Steps and Career path

I intend to continue building my career in epidemiology, surveillance with emphasis on maternal and child health.
I also plan to be actively involved in research in MCH, HIV and communicable diseases.