Deliver training to nurses and midwives in health facilities—where they deliver babies—and more women and their newborns will have safer births, the study published December 17 in PLOS ONE demonstrates.
Onsite trainings that feature shortened, simulation-based lessons with support for practice led to a 17% decrease in postpartum hemorrhage, a 47% decrease in retained placenta, a 34% decrease in stillbirth and a 62% decrease in newborn death across 125 public facilities in Uganda.
“Traditional training approaches have not worked,” lead author Cherrie Evans says, referring to in-service workshops taught by outside experts to large groups gathered for a week or more in hotel conference rooms across sub-Saharan Africa. “Skills are taught and competencies are ‘learned,’ in so far as the attendees pass tests at the end of these events. But the literature shows that this strategy has not meaningfully changed how health care providers care for people day in and day out and, as a result, haven’t impacted survival when mothers hemorrhage or babies fail to breathe at birth.”
The study authors worked with the Ugandan Ministry of Health to move lessons onsite, shorten training sessions, and put midwives’ own peers (in this case, local Ugandan staff) in charge of leading short, simulation-based practice after training. Using the Bleeding after Birth and Helping Babies Breathe training modules, they tested the approach in Western and Eastern Uganda that lasted from January 2014 to October 2015.
A total of 755 midwives, nurses and doctors were trained in 125 facilities covering more than 70,000 births. “The evidence shows that if providers learn with the team they work with, in the setting where they work, they are more likely to change their practices and maintain skills and competencies well after the training is over,” says Evans, DrPH, a senior maternal and newborn health advisor at Jhpiego where she directs Helping Mothers Survive.
“This important study advances our understanding around the most critical question confronting global health today—understanding how provider performance can be sustainably improved,” says Thomas F. Burke, MD, Chief of Global Health and Human Rights, Massachusetts General Hospital, Harvard Medical School. “Dr. Evans and team teach us that critical elements of state-of-the art implementation efforts should include: “light touch, rapid cycling, and team training.”
Reducing maternal and newborn death rates in developing countries depends on marshalling a skilled, competent health workforce and, as critical, a strong health system. The latter, however, requires a series of fixes across a variety of categories—supply chains, data collection, and infrastructure—that take time.
“While we wait for enough funding to strengthen entire health systems, we can significantly increase newborn survival and prevent maternal complications with just this very simple, inexpensive training intervention that builds caregiver confidence and competence, and ultimately improves performance,” Evans says.
Peer-assisted learning after onsite, low-dose, high-frequency training and practice on simulators to prevent and treat postpartum hemorrhage and neonatal asphyxia: A pragmatic trial in 12 districts in Uganda was written by Cherrie Lynn Evans, Eva Bazant, Innocent Atukunda, Emma Williams, Susan Niermeyer, Cyndi Hiner, Ryan Zahn, Rose Namugerwa, Anthony Mbonye, Diwakar Mohan.
Funding was provided by Saving Lives at Birth partners: United States Agency for International Development (USAID); Government of Norway; Bill & Melinda Gates Foundation; Grand Challenges Canada, and the UK Government.Tags: high-frequency low-dose performance SLAB study training