Last week was full of travel! On Wednesday, we had the opportunity to head to Lilongwe for the annual CPAP Coordinator Peer Review Meeting where each of the twenty-eight hospital coordinators come together to present their hospital’s previous year of data collection, CPAP successes and challenges, and action plans for the coming year. This meeting was a great chance for us to see yet another side of program planning and implementation: How can we assess success and failure in a way that leads to progress and sustainable planning for the future use of CPAP in Malawi?

We were able to see a lot of motivated coordinators, but the major challenges that each of them face will require hard work in the coming year. Despite regular trainings for hospital staff, CPAP coordinators struggle to keep trained nurses in the maternity and neonatal wards due to frequent staff rotations by management. A lack of trained staff on the wards then leads to a lack of confidence in putting patients on CPAP, so patients put on CPAP steadily decline as trained nurses rotate out. Keeping trained staff available requires strong advocacy and lobbying by hospital coordinators as they work with management to prioritize improving neonatal care.

Several hospitals also struggled to collect ample amounts of data due to already short-staffed nurseries, and the 4-hour monitoring requirements for patients on CPAP increase workload on the already overwhelmed nurses. In some cases, hospital coordinators reported having as many as 70 babies in a nursery staffed by just a single nurse. In a project where data is one of the most powerful tools for proving CPAP’s effectiveness, it becomes critical to understand the barriers to collecting and recording that data. In this sense, the meeting was incredibly helpful, as it allowed a forum for coordinators to come together to see how other districts were performing, which data collection strategies were showing success, and discuss ideas for further improvement. The exchange of ideas and enthusiasm was exciting to watch as each hospital drafted an action plan for the next three months at the end of the meeting.

The peer-review style of discussion was a great way to increase both enthusiasm and accountability for each hospital coordinator. By presenting his or her hospital’s progress to the group, each coordinator was able to critically evaluate his or her work and identify areas of success as well as areas of improvement. There were also nine coordinators from Phase III hospitals in attendance, and Phase III hospitals are gearing up for CPAP installation in August. This meeting gave them a chance to learn from their Phase I and Phase II colleagues on how to mitigate challenges from the outset, and the meeting fostered discussion between these newer CPAP hospitals and hospitals that have been operating with CPAP for some time now. The energy from the Phase III coordinators also added a unique element to the meeting, and it will be exciting to see how their implementation plans move forward in August upon installation!