Improved outcomes for newborns in Limpopo and elsewhere
The Limpopo initiative for Newborn Care (LINC) is a provincial programme that was established in 2003 to improve the quality of all aspects of newborn care in all district and regional hospitals in Limpopo Province.
LINC was established as a partnership between the Department of Paediatrics and Child Health at the University of Limpopo, the Centre for Rural Health under the University of KwaZulu-Natal and the Maternal Child and Women's Health division of the provincial Department of Health and has laid the foundations for a fully functional provincial neonatal service. Before the initiative was established, sick newborns were often unrecognised, their management was inadequate and referral did not take place, even when it was necessary. The tertiary referral hospital had only a ten-bed neonatal unit for a province of over five million people where international data shows that more than six times that number of beds were needed.
LINC's first tangible impact was the expansion and availability of appropriate facilities at the regional and provincial level. The tertiary level facility now has 60 beds and runs at full capacity and all district hospitals have established neonatal units - even if some have only three beds - and all but one have rooms for kangaroo mother care.
Another significant impact has been the establishment of a support network of hospitals that allows the referral of sick newborns up the chain of hospitals to the appropriate referral level. This hardly existed before the LINC initiative raised awareness, prioritised the identification of sick and small newborns and strengthened referral facilities.
LINC training has given nurses and doctors the skills, knowledge and confidence to recognise, manage and treat small and sick newborns. This has had a direct impact on the quality of care that is evident in all the monitoring data that is collected. For newborns over 999g, the provincial early neonatal mortality rates decreased overall by 8% from 2006 to 2009, and the overall neonatal mortality rates have decreased by 5% in the same period.