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The Solution

Enhancing ill-equipped labour rooms and improving knowledge and skills of delivery nurses

Disorganised and inadequately equipped facilities are one of the key reasons why the public health system is unable to deliver expected impact. In addition, knowledge and skills of medical workers at facilities are below par and not refreshed on a regular basis. Protocols are either not established or duly followed.

As part of this intervention, The Antara Foundation (TAF) focuses on enhancing ill-equipped public health facilities and training low-skilled medical workers in high caseload delivery points. Nurse mentoring involves a comprehensive six-week training cycle that is imparted to the labour room staff of these facilities. The training ranges from labour room organisation to complication management. The nurse mentors use a combination of theoretical and bedside teaching methods with the help of simulations on models. Clear protocols are displayed in each labour room, and a thorough check is carried out to ensure that they adhere to government guidelines.

We also work to create master trainers among government supervisors who can cascade training within their blocks, and train labour room staff on a regular basis.

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Status

The nurse mentoring program was carried out in high case load delivery points in Jhalawar and Baran districts in Rajasthan, and is now being implemented in Mahasamund district in Chhattisgarh

* Our Senior Nurse Mentor conducting a training session on labour room organization

Rajasthan

As part of the Akshada program in Rajasthan, the nurse mentoring program was carried out in five high-case load delivery points each across Jhalawar and Baran districts, covering around 60% of the total public health institutional deliveries. The intervention also focused on setting up mini skill labs, analysing data trends from live delivery observations and tracking improvement in outcome indicators related to complication management. Other non-mentees, not part of the direct six weeks training, were also provided on-the-job training by our nurse mentors based on their knowledge assessment. These steps have created an environment for the program to self-sustain.

While the initiative continued through the government system in Baran, our monitoring efforts focused on Jhalawar district. The status of the program in Jhalawar is as below:

  • Completion of training of nurse mentees from five high case load delivery points
  • Initiation of mini skill labs in all blocks
  • Over 200 live observations by the TAF team for deliveries conducted by trained nurse mentees

In late 2018, the state team visited one of our intervention facilities in Baran and commended the knowledge and skills of the staff nurse there, as well as the organisation of the labour room. The staff nurse voiced her appreciation towards the Akshada program and our team of nurse mentors.

Chhattisgarh

The solution is now being implemented in Bagbahara block, Mahasamund district as part of TAF’s Aadhya program in Chhattisgarh. Based on our assessment conducted across 24 Sub-health Centre (SHC) labour rooms in the block, we decided to prioritise labour room strengthening. Training on labour room organization has been conducted for all SHC delivery point ANMs on government protocols. Follow up and technical assistance is being provided to selected 12 high case load delivery points.

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Impact

Improved facility readiness, and knowledge and skills of staff nurses to ensure reduction in maternal and child mortality

Rajasthan

The nurse mentoring and facility enhancement program has had high impact on the availability of equipment as well as knowledge and skills of medical workers in Jhalawar and Baran districts. Management of complications during labour at primary health centres has been enhanced, providing better service closer to far-to-reach villages. Based on the pre-post test scores conducted before and after training the nurses every week, there has been a significant improvement in the knowledge of nurses. There has also been a remarkable increase in skills. Some indicators for Jhalawar are listed below:

Facility Enhancement

Akshada’s (TAF's flagship program in Rajasthan) focus has been to constantly improve the delivery readiness of facility both in terms of equipment as well as consumables. The overall score of facilities under the program has shown significant improvement, with the facility readiness score rising from 47% in October 2016 to 98% in March 2019.

  • Fe Better Image

Delivery readiness scores (overall) for all 5 facilities

Improvement in knowledge of staff nurses

Nurses deployed in labour rooms who have been trained by Akshada under the nurse mentoring program, have shown significant improvement in their knowledge of labour room organization and infection prevention (increase by 82%), managing labour cases (increase by 74%) and managing complications during labour (increase by 65%). These nurses are now able to better manage labour cases and complications thereby directly impacting maternal mortality and neo-natal mortality.

  • Improvement In Knowledge Of Staff Nurses

Pre and post assessment scores of nurse mentees

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Case Studies

Stories from the field

Management of breech twins by Antara Foundation trained nurse mentee