Novel training approaches to improve maternal and newborn health outcomes

Global Health Mini-University

22 October 2018

Session Objectives

▪ Describe the Low Dose, High Frequency (LDHF) approach and how it compares with traditional training approaches in promoting retention of clinical competencies and improving patient outcomes.

▪ Simulate use of a Helping Mothers Survive (HMS) learning module using the LDHF approach.

▪ Present outcome data to show the effectiveness of the LDHF training methodology.

2

What Does Learning Usually Look Like?

3

Is This the Best Way to Learn?

4

The Cone of Learning: learners retain

Is This the Best Way to Learn?

From: https://www.e-learningstudios.com/single-post/2015/04/16/Blended-Learning-and-702010

What does the evidence tell us?

So Then…What Does Work?

▪ Technique: Focus on practice and simulation, not lecture.

▪ Setting: Hold in workplaces, not off site.

▪ Frequency: Offer low-dose, high-frequency as an alternative to one long course.

▪ Media: Enhances effectiveness and efficiency.

7

Is this better?

8

Evidence-based learning is…

1. Competency-focused

2. Hands-on

3. Interactive

4. Team-based

5. Onsite

6. Thoughtfully designed and sequenced

7. Ongoing

8. Optimizes technology

9. Addresses gaps

10. Improves quality of care and results

Helping Mothers Survive and Helping Babies Survive build upon these principles

Weekly

Practice

Weekly

Practice

Weekly

Practice

Weekly

Practice

Weekly

Practice

Weekly

Practice

Weekly

Practice

1-day BAB

training

HEALTH FACILITY

Clinical Mentor

BAB/HBB District Trainer

Low-Dose, High-Frequency : The Uganda Saving Lives at Birth Example

Repeated with HBB

12 Districts125 Hospitals> 700 Providers> 70,000 deliveries

Low-Dose, High-Frequency:The DRC Spacing After Safe Delivery Project

Four to 5 days of training followed by at least 3 practice weeks on simulators.

Practice Week

Practice Week

Practice Week

4 /5 days

Master Trainers* Clinical Coordinators+ Providers

Health facility

*Accessible during training and returned for coaching during practice weeks.

What did we learn from Uganda and DRC?

InterventionContentScaleProgramApplying

LDHF

LDHF applications

DRC: Spacing after Safe Delivery

(SSD)

Kinshasa

16 health centers

Day of BirthPPFPPAC

Pre-term labor, care of small

newborns and maternal and

newborn infections

4-5 day on-site trainings for each

session with 1 month in between.

Master trainers, clinical coordinators, peer

mentorship and practice, mMentoring

Uganda: Saving Lives at Birth

(SL@B)

3 Regions12 Districts

125 Facilities

Helping Babies Breathe (HBB) & Helping Mothers Survive Bleeding After Birth (BAB)

1-day onsite learning (x2) onsite practice

sessions

District trainers, clinical mentors, peer

mentorship and practice, mMentoring

What did we learn from these two studies?

▪ It works!

✓Facility- and simulation-based on-the-job (OJT) training and mentoring is feasible, and resulted in gains in performance and health outcomes.

▪ Local capacity

✓OJT trainers should come from the districts where they work and be mentored during their first OJT facilitation.

▪ More = Better

✓More practice equals better performance.

▪ Support Practice

✓Practice is essential, but maintaining practice needs support.

▪ On site

✓Support for practice must be centered in the health facility.

▪ Good design

✓A combination of mentoring and team training fosters a culture of change.

14

Summary: Effective approaches build on what works…

▪ Situates context-specific capacity-building interventions within broader continuous quality improvement.

▪ Marks a shift from traditional training toward shorter, repeated, team-oriented, workplace-based learning activities.

▪ Stresses ongoing learning reinforcement to build a culture of quality.

▪ Aims to link learning interventions with impact and outcome (rather than output) measures.

15

Evaluation Results

• 16 Mentors > 186 Providers

• 11,851 delivery records

• 52% ↓ early perinatal mortality

• 46% ↓ PPH

• 75% increase in proper treatment of PE/E

DRC

Cluster randomized trial2-arm (completed 1 arm at this

time)

(outcomes from facility records)

• 24 District Trainers > 153 Mentors > 604 Providers

• 87,078 delivery records

• 62% ↓ newborn mortality rate

• 34% ↓ intrapartum stillbirth rate

• 17% ↓ PPH; 47% ↓ retained placenta

Uganda SL@B

Cluster randomized trial 3-arm

(outcomes from facility records)

THANK YOU!