Skills Laboratory for MO/SN/ANM - Bihar Experiences

1. Skills Laboratory for MO/SN/ANM- Bihar Experiences UNICEF BIHAR TEAM

3. Our Challenges BIHAR • 3.0m live births annually • 0.13m die before 4week of age • 0.17m die before completing 1year • 0.27m die before completing 5years • 9360 mothers die in this process INDIA • 27m live births annually • 1.1m die before 4week of age • 1.7m die before completing 1year • 2.2m die before completing 5years • 137000 mothers die in this process

4. OUR CHALLANGES Source: SHSB Report(2013)

5. Determinants for Bottleneck Analysis (BA)

6. 16 Tracer Interventions selected for Bottleneck Analysis • Community Services • Postnatal Care (PNC) • Diarrhoea management • Pneumonia management • Exclusive Breast Feeding • Home Delivery • Improved sanitation • Outreach Services • Full ANC • Full Immunization • Family planning • Vit A • Facility Services • Basic Emergency Obstetric Care • Newborn Stabilization Unit (NBSU) • CEmoC • SNCU • Nutritional Rehabilitation Center (NRC) • PPTCT • F-IMNCI

7. Full Ante Natal Care (F-ANC) Strategic priority • Establishment of Skills Lab to improve competencies amongst ANMs • Mentoring & Monitoring of VHND by Block Health Educators and female supervisors • Provide privacy by use of screens • IPC/Counselling & media mix to increase knowledge on health services • Digital BP apparatus needs periodical calibration and replacement of batteries Bottlenecks: • Quality of basic and in-service training of ANM is more informative than skill building • Supply management • No mentoring • No Privacy for Antenatal checkup in outreach sessions • Poor quality of care leading to poor utilization of services

8. Delivery by Skilled Birth Attendance (SBA) Bottleneck: • Poor quality of training • Irrational Deployment HR-Skewed workload • Quality infrastructure-WASH • Inadequate specialists and mentoring, motivation • Strategy Priority : • Skill development • Regular mentoring • Hardship allowance and Incentives based on performance

9. Quality of basic and in-service training of ANM is more informative than skill building

10. Overview • The context in which the Skills Lab established? • The benefits/strengths of Skills Lab? • Genesis, Methodology, Processes, Mentoring/monitoring • The main challenges or limitations faced (and why)? • Managerial consequences?

11. What is Skills Laboratory ? Skills Lab is a Competency/Skills based learning to reinforce capacity of health care providers on the day to day practiced skills and knowledge's to ensure quality of RMNCH services along with timely mentoring provision.

12. Background • Capacity development • a continuous process integral to development of skills. • Now, modular have become skills based • But, in reality, sufficient time or importance not given to skills practice though enough time has been allocated for training as well as skills practice. • The trainees get exposed to modern theories and practices, but their actual skill practice in the field remains poor

13. Background…cont… • Capacity development.. • Urgent need was realized to assess the skills learnt and to correct the errors in skill application so that quality of care will be ensured • Redesigning the training curriculum focusing on skill improvement was realized as effective strategy for the long run

14. Objectives • To fill up the gaps in the skill based learning • To rectify errors, which are likely to creep in during the course of service provision • To improve the confidence level of the care providers to utilize the equipment for life saving procedures

15. 3-Day Skill Development programme • A three days residential training programme • 20 participants per batch & criteria of selection of participants • Trained in SBA/F-IMNCI/IMNCI/NSSK/EmONC • Posted in LR- L1/L2/L3 centers • 5 sub groups with average 4 participants in each group • A total of 7 facilitators per batch (4 MOs & 3 SNs) • Covers 33 key knowledge & skills in 33 different stations and practice on Mannequins, Equipment etc. • Every day 11skills stations are covered • 4 observed skill stations (15-30 minutes) • 7 applied Skills stations (30 min- 2 hrs)

16. Whole training divided into 4 parts: • PHASE I:Pre training Assessment: Existing skills and knowledge of the health care providers are assessed objectively. • PHASE II: Demonstration & Practice: Facilitator demonstrates the correct steps and encourages the trainees to practice). • PHASE III: Class room Discussion At the end of each day the knowledge parts are discussed through interactive classroom session • Phase IV: Mentoring phase : Trainees are followed up at the field and provided hands-on-support

17. PHASE I: Pre training Assessment Existing skills and knowledge of the health care providers are assessed objectively • Adequate knowledge about the skill • Correct technique / method • Right sequence/steps • Analysis/Interpretation • Decision making and action taking in given situations.

18. PHASE II: Demonstration & Practice Facilitator demonstrates the correct steps and encourages the trainees to practice. • Facilitator demonstrates a given situation and allows each trainee to practice till mastering. • Opportunity to learn from each other.

19. PHASE III: Class room Discussion At the end of each day the knowledge parts are discussed through interactive classroom session using a LCD projector • Detail discussion on each knowledge station • Discussion on technical & managerial aspects based on field experience of service providers

20. Phase IV: Mentoring phase Trainees are followed up at the field and provided on-the-job supportive supervision • Self Assessment Tools (SAT) • Problems identified/ Actions taken/Action required at higher level

21. Progress so far…. • Seven Skill labs set up in Bihar at district level: GGS Hospital Patna & SIHFW Patna, Vaishali, Darbhanga, Bhagalpur, Purnea & Gaya districts . • A pool of 40 Master Trainers (22 MOs & 18 SNs) created • 1563 (MOs/SNs/ANMs-) trained • 882 (57%) trained health staff are mentored & monitored. The key skills/knowledge retention and practice were assessed. Regular On-the-job mentoring has a positive effect in skills building and retention • Visible changes in the skills which are used daily like • Measuring birth weight, • hand washing, • use of suction machine, oxygen concentrators, RW,autoclave • steps of normal delivery, AMTSL etc.

22. Some initial results

23. A total of 882 (57%) trained Service Providers mentored and provided On-the-Job support

24. ANTENATAL CARE

26. NATAL CARE

28. POST NATAL CARE (PNC)

30. ESSENTIAL NEWBORN CARE (ENC)

33. INFECTION CONTROL

35. DIARRHOEA DIAGNOSIS & TREATMENT

37. ROUTINE IMMUNIZATION

39. DOMAIN WISE PRE TRAINING ASSESSMENT Vs FOLLOW UP RESULT

44. Challenges • Getting qualified and skilled trainers • Weak O&M support from the suppliers of the equipment – challenge of spread –hampering the hands-on practice by ANM/SN • Changing behavior and age-old practices of staff • Timely mentoring support to trained service provider for skill retention

45. Thank You