Enhancing ill-equipped labor rooms and improving knowledge and skills of delivery nurses
Disorganized 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, we focus 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 labor room staff of these facilities. The training ranges from labor room organization 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 labor 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 labor room staff on a regular basis.
Improved facility readiness, and knowledge and skills of staff nurses to ensure reduction in maternal and child mortality
The nurse mentoring program was carried out in five high-volume delivery points each in two districts in Rajasthan, covering around 60% of the total public health institutional deliveries. The intervention also focused on setting up mini skill labs, analyzing data trends from live delivery observations and tracking improvement in outcome indicators related to complication management. Other nurses, 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.
The program had high impact on the availability of equipment as well as knowledge and skills of medical workers in both districts. Management of complications during labor at primary health centers was 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, we see a significant improvement in the knowledge of nurses. There has also been a remarkable increase in skills. Some indicators for one of the districts are listed below:
The program greatly improved the delivery readiness of facilities, both in terms of equipment as well as consumables. The overall score of facilities under the program has shown significant improvement, with the overall facility readiness score rising from 47% in October 2016 to 98% in March 2019.
Improvement in knowledge of staff nurses
Nurses deployed in labor rooms who were trained under the nurse mentoring program, have shown significant improvement in their knowledge of labor room organization and infection prevention (increase by 82%), managing labor cases (increase by 74%) and managing complications during labor (increase by 65%). These nurses are now able to better manage labor cases and complications, thereby directly impacting maternal mortality and neo-natal mortality.