Training to StrengthenCare around BirthAn experiential training designed to enhance competencies to deliver evidence based, high impact interventions that will help to reduce preventable maternal and newborn deaths.

VRIDDHI has drawn upon the experience and knowledge from successful interventions, while developing its own capacity building approach to strengthen care in the critical period around birth. Training of service providers is the first step within the broader capacity development approach. It recognizes that providing services at scale, which is the full package of services for every mother and newborn requires not just enhanced knowledge and skills but also capacity and motivation to address common problems and challenges that prevent delivery of well-organized services. Hence the training design is based on adult learning principles and uses an experiential approach.

Training ConTexT

Training aT a glanCe

Vriddhi: Scaling Up rMNCh+A interventions a USAID supported project is the culmination of a series of actions starting with a call to action to reduce preventable maternal and child deaths in 2012 and the subsequent development and roll out of the RMNCH+A strategy by the Government of India. USAID, which played a pivotal role in the entire process is now providing technical assistance to the National government and six states – Delhi, Haryana, Himachal Pradesh, Jharkhand, Punjab and Uttarakhand through VRIDDHI. The project team consists of a National Technical Support Unit, State RMNCH+A Units and District Technical Officers posted at 30 high priority districts in the six USAID supported states.

Mandated to reduce preventable maternal and child deaths, VRIDDHI has identified strengthening Care around Birth as its central pillar, because improving services and practices during the intra-partum and immediate post-partum period has potential to save maximum maternal and newborn lives. The strategy aims to improve the scale and quality of evidence based high impact interventions that can ad-dress the common causes of mater-

nal and newborn deaths during and immediately after child birth.

The technical intervention package to strengthen ‘Care around Birth’ has been designed in two phases. The first phase, Technical Intervention Package-1 (TIP-1), lays emphasis on strengthening the universal interventions for mothers and newborns, while the second phase TIP-2 focuses on the management of complications.

AimTo strengthen delivery

of recommended evidence based high-impact practices to every woman and newborn in public health facilities.

ApproAchA participant centred,

experiential approach was used to maximize learning, and enhance knowledge and skills as well as encourage development of desired attitudes.

principlesTraining design was based

on adult learning principles of fa-cilitating learning and not teach-ing, encouraging participants’ to build upon their past experience and apply training lessons to solve problems in their workplace.

contentTechnical Intervention

Package – I combined technical interventions, health systems strengthening efforts with due emphasis on Respectful Maternity Care.

TeChNiCAl iNTerVeNTioN PACkAge - 1

Essential Childbirth Care and Labor Monitoring

Active Management of Third Stage of Labor

Essential Newborn Care and Resuscitation

Newborn Vaccination

Postnatal Monitoring and Counselling at Discharge

TeChNiCAl iNTerVeNTioN PACkAge - 2

Management of Post-Partum Hemorrhage

Management of Pre-eclampsia and Eclampsia

Care of Small and Sick Newborns

Management of Pre-Term Labor

Management of Maternal and Newborn Infections

Health Systems Strengthening and Respectful Maternity Care

Techincal inTervenTion packages care around BirTh

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Training FeaTureS seAmless sequencing The training sessions followed the sequence of events at birth and emphasised the need to move seamlessly between the mother and newborn to ensure timely care.

comprehensive Respectful Maternity Care, service delivery protocols and documentation were an integral part of the training design.

experientiAl leArning The trainng followed a process of ‘Demonstration, Learning, Practice, Sharing, and Performance (DLPSP)’. It begins with demonstration of skills/knowledge, followed by learning by observing correct procedures and processes, practice by doing in facilitated small groups, sharing of problems, challenges and solutions and performing new skills in training as well as at work place after the training.

optimAl use of time During the training the time allocated for practice sessions (50%)

was more than time allocated for discussions in the plenary (27%) session (see Pie Chart above).

leArning AmBience A conducive learning environment was created by ensuring a non-threatening approach and by grooming trainers to be non-judgemental, cheerful, patient and sensitive.

sustAining interestSustained energy and interest of participants were ensured by sequencing of training methods, ensuring everyone was heard and got a chance to practice, taking short breaks for team games, and frequent re-grouping of participants.

The project technical team at national, state and district levels were the primary facilitators and mentors for the training which was rolled out over a period of three months for labour room staff in 141 high case load facilities in the HPDs of the six focus states.

Training implemenTaTion

trAiners’ mAnuAl

The trainers’ manual is a compilation of the full training package and aims to provide guidance on the conduct of the training. Each session in the manual, is a self-contained module replete with detailed instructions on the participatory process, work-sheets and handouts.

pArticipAntsFacility staff who

provide intrapartum and immediate postpartum care - primarily the nursing staff, auxiliary nurse midwives and medical officers.

methodsA variety of

participatory training methods were used including working in dyads and triads, visualization in participatory planning (VIPP), demonstration,simulation, case studies, practice on mannequins, and role plays.

durAtionThe trainers’ guide has been

designed for two-day training of labour room staff. The total duration of the training when implemented as a package is 16 hours. In case the full training package is not needed or feasible, individual sessions maybe delivered in short incremental trainings at facility level.

Time Allocated for Training Sessions (%)

50%Practice Sessions

Plenary Discussions

PresentationMeasurem

ent

of Learning

7%

7%

9%

27%Instructions

for ativities

creaTing FaciliTaTorsThe entire technical team of the project underwent a three day training of trainers to familiarize them with the training methodology, the technical content and the final two-day training package for facility staff. The team was guided on their roles as facilitators and encouraged to inculcate mentoring skills to be ‘actively passive and passively active’ - observe and listen carefully and curb the tendency to teach rather than facilitate learning.

disTricT level TrainingsDistrict level trainers in groups of 3-4, facilitated trainings in 26 HPDs of the 6 focus states, for the labor room staff of the supported facilities. National team mentored the first district level training in each state. In subsequent rounds of district level trainings the state teams mentored district level trainers.

onsiTe Training The final lap of training for the remaining labour room staff was delivered at facility in short, ‘low dose high frequency’ format. In many instances the Medical Officers and Specialists participated as co-facilitators and became champions of change in their facilities.

Photo: SRU Himanchal Pradesh

DISCLAIMER: This document is made possible by the generous support of the American People through the United States Agency for International Development (USAID). The contents are the responsibility of IPE Global Limited and do not necessarily reflect the views of USAID or the United States Government.

To know more about the Training and the Project, Write to: VriDDHi: SCaling up rmnCH+a inTerVenTionS/uSaiDipe global ltd – IPE Global House B-84, Defence Colony, New Delhi – 110024Email: rmncha@ipeglobal.com

Published in August, 2016

Cover Photo:SRU Punjab

Design © PealiDezinepeali.duttagupta@gmail.com

The enhanced knowledge and skills have helped to instill confidence among the labor room staff to translate knowledge into action. Early indications of change include increasing and correct use of partograph to monitor labor, adoption of essential newborn care practices and resuscitation. There is increased focus on maintenance of records and

labour room staff are demonstrating improved infection control practices. Change is further encouraged by specialists in the facilities and peer to peer interactions on social media.

Training ouTpuTS

hArBingers of chAnge

• Overall 1,230 medical officers and staff nurses have been trained.

• Multiple-choice questions administered for pre-and post-test indicated at least 28% increase in knoweldge levels, as shown in below diagram.

iNCreASe iN kNowledge leVelS of TrAiNiNg PArTiCiPANTS froM foCUS STATeS

Pre-Test

Post-Test

Delhi (n=61)

48.1%

78.8%

Haryana (n=137)

58.4%

77.2%

HP (n=66)

69.4%

41.6%

Jharkhand (n=209)

75.1%

44.5%

Punjab (n=53)

74%

46.7%

Uttarakhand (n=58)

72.5%

48.2%

• Implement the capacity building approach that includes training follow up and onsite mentoring, engaging facility level team to overcome barriers in service delivery and tracking progress.

• Nurture, sensitize and activate the newly constituted quality improvement teams at the facilities to create

the supportive environment for change in practices in the labor room.

• Gather evidence of change by collecting data on key practices and documenting qualitative improvements disseminate learnings and evidence of impact at experience sharing platforms in districts and state to broaden the scope of the intervention.

Way ForWarD

“I see a significant increase in confidence level of the staff

and motivation to strengthen care around birth.”

dr. ArchAnA srivAstAvAAdditional Director, National Health Programmes,

State Health Department, Uttarakhand

“Yesterday night a breech baby needed resuscitation and we used learnings from the training to save the baby’s life.”

–Labour Room Nurse, Community Health Centre Karsog, Mandi, Himachal Pradesh

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