Sustaining Clinical Skills for Frontline Providers: Helping Mothers/Babies Survive

These trainings address critical causes of maternal and newborn mortality:

• Essential Newborn Care 1 (Helping Babies Breathe) – providing immediate ventilation for babies born with asphyxia
• Essential Newborn Care 2 (Essential Care for Every Baby) – assessment and care within the first 24 hours of life
• Bleeding After Birth -prevention and treatment of postpartum hemorrhage, the leading cause of maternal mortality globally
• Essential Care for Labor and Delivery – monitoring mothers for early detection and management of abnormal signs and symptoms
• Pre-eclampsia/Eclampsia identifying and managing this life-threatening illness
• Pre-referral Care if High Risk of Preterm Birth identifying mothers at risk of preterm labor, providing early management and appropriate referral

We didn’t stop there. A program like this is only successful if skills and knowledge are sustained. We have a two pronged approach.

• New frontline providers receive extensive training within a year of being hired
• All providers undergo refresher training, called Low Dose High Frequency training, or LDHF.

Low Dose High Frequency follow-up training

Keeping the skills and knowledge of six modules for over 100 providers in 26 health centers up to date in this region of approximately 1300 square miles (the size of Rhode Island) is no easy task. However, the Uganda WOtW team developed a program with the following components:

• Eight-week rotating training cycles
• Shared equipment across facilities
• Incorporation of health care providers staffing smaller health centers into training sessions
• Collaborative peer to peer learning
• Mentorship and coaching by WOtW midwife trainers
• Access to WOtW midwife trainers for urgent consultation

Not only has this model been successful, it has received national recognition in Uganda. After requesting WOtW to present their program to the National Safe Motherhood Conference in Uganda, the Ugandan Ministry of Health has adopted the WOtW LDHF model, and has started implementation in other regions.
That is a true measure of success. Key to this locally developed program is that it is:

• Affordable
• Scalable
• Sustainable

Impact:

Impact is in the data. Gulu District has consistently had a lower institutional perinatal mortality rate than a demographically and geographically comparable district – and even lower than the national Ugandan institutional perinatal mortality rate!

Training implementation involves close collaboration with a group of highly skilled Ugandan midwives to ensure that each training is consistent with Ugandan Ministry of Health guidelines and applicable to the realities of the setting in which the health care providers work. The US and Ugandan teams combine medical knowledge, donated materials and established training programs with Ministry of Health guidelines and social/cultural frameworks to create broadly applicable training programs. The US and Ugandan teams are proud of our project, as it is built on a foundation of collaboration based on shared respect, planning and decision making, with the vision of ensuring that every mother and baby gets off to a healthy start.