CASCADING HELPING BABIES BREATHE SKILLS THROUGH TRAINER OF TRAINERS: THE CASE OF KENYA AND UGANDA

Wamuyu-Maina, G1, Omondi, C1 and Miheso, G2 1Regional Center for Quality of Health Care, Kampala Uganda, 2USAID East Africa, Nairobi Kenya

INTRODUCTION (1)
The neonatal period (first four weeks or 28 days of life), carries one of the highest risks of death Neonatal deaths have been observed to be persistently high in Sub-Saharan countries 80% of the newborn deaths are due to three major causes namely : Infections Prematurity Low birth weight as well as birth asphyxia Birth asphyxia, which is the inability to breathe immediately after delivery needs to be dealt with within the first minute of life hence resuscitation must be anticipated at each delivery.

INTRDUCTION (2)
To strengthen essential newborn care including resuscitation knowledge and skills at regional and country level, with support from partners, the Regional Centre for Quality Health Care (RCQHC) in collaboration with the East Central and Southern Africa Health Community (ECSA-HC ) are rolling out the Helping Babies Breathe (HBB) training Training aim To increase the number of trainer of trainers (ToTs) specifically nurses and midwives at regional and country level who can transfer quality competency-based training skills in essential newborn care, including newborn resuscitation, to skilled birth attendants

TOTS TRAINED
Between 2011 and 2013, 332 HBB ToTs trained through regional and in-country trainings
Month & Year of Training REGIONAL TRAINING February 2011 1. Ethiopia1, 2 August 2012 2. Uganda2 IN-COUNTRY TRAINING August 2011 1. Zambia 1 June 2012 2. Rwanda1 May 2012 3. Tanzania 1 September 2011 4. Kenya 2 December 2011 5. Uganda2 February 2013 6. Burundi2 TOTAL Country
Training coordinated /supported by partners and 1

Number Trained 14 32 30 29 30 81 77 39 332

ECSA-HC; 2 RCQHC

COUNTRIES REACHED
17 ECSA countries

Djibouti S. Sudan Uganda Rwanda Burundi DRC Zambia Botswana South Africa Kenya Tanzania Malawi Zimbabwe Swaziland Lesotho Seychelles Mauritius

METHODS (1)
HBB ToT post training follow-up conducted in Kenya & Uganda Seven to nine months after training ( Between June 2012 and September 2012) In partnership with Ministry of Health; National Nursing Associations & Councils, National HBB facilitators, East Central and Southern Africa College of Nursing (ECSACON) country chapters. Using predesigned monitoring tools developed by partners to gather quantitative and qualitative data

METHODS (2)
Visited 47 health facilities/institutions (31 Kenya; 16 Uganda) Interviewed 105 out of 157 (69%) HBB ToTs Kenya: 45 out of 76 HBB ToTs from 13 of the 25 participating districts Uganda: 60 out of 81 HBB ToTs from 15 of the 19 participating districts 177 cascade trainees

METHODS (3)
Assessed HBB ToTs cascade trainings conducted HBB ToTs and cascade trainees Post-training knowledge and skills retention using written post-test as well as Observed Structured Clinical Evaluation (OSCE B) Perceptions regarding the HBB training content suitability, adequacy and adaptability Provided support to the HBB ToTs and cascade trainees to address field challenges and needs identified

HBB CASCADE TRAININGS CONDUCTED

Over 3,000 health workers trained by the 105 HBB ToTs interviewed Training roll out largely facilitated by: Availability of the training materials Training of a pair of health workers from a health facility/ training institution Support from the institutional as well as nursing council administration
Table 1. HBB Cascade Trainees by Mode of Training, Kenya and Uganda
CASCADE TRAINEES BY MODE OF TOTAL NUMBER COUNTRY TRAINING OF CASCADE TRAINEES CME Training On Job Class Labour wards Training room teaching 726 Uganda 204 61 109 352 Kenya 1185 890 75 654 2804 Total 1389 951 184 956 3530

POST-TRAINING KNOWLEDGE AND SKILLS RETENTION (1)

Generally, both TOTs and cascade trainees demonstrated good knowledge and high skills retention follow-up post tests and OSCE B assessments

A TOT demonstration OSCE B during the follow-up

POST-TRAINING KNOWLEDGE AND SKILLS RETENTION (2)

PERCEPTIONS REGARDING THE HBB TRAINING CONTENT

The training content was appreciated by both the ToTs and cascade trainees for the new learning, comprehensiveness and ease of adoption I gained new learning from the training, for example stimulating the baby to breath by gentle rubbing on the back other than slapping the feet. (Cascade trainee, Uganda) The training content is adequate as it covers care and resuscitation during the most critical period that is the Golden minute, after birth and there after as the babies condition will demand. (HBB ToT, Kenya) It is easily adaptable as its not sophisticated, uses available resources more so human resources that is in short supply, needs few people to achieve desired results, can be used by all cadres after short training using the training materials. (HBB TOT, Kenya)

CONCLUSIONS
HBB ToTs were instrumental in the cascade and scale up of HBB training Roll of HBB has greatly benefitted from support, leadership and in-house resources from countries, professional associations, councils and structures Skills retention amongst both the HBB ToTs and cascade trainees was appreciable The HBB training was appreciated for its simplicity, practicality and comprehensiveness

RECOMMENDATIONS
Enhanced advocacy to policy makers and private sector partners is required to create awareness and solicit in-house and external support for scaling-up HBB on-job and preservice training as well as acquisitions of training materials. To assess and document impact, monitoring should be built into the existing structures/programs and curricula of nursing schools.

ACKNOWLEDGEMENTS
East, Central, Southern Africa Health Community (ECSA-HC) East, Central, Southern African College of Nursing (ECSACON) Country Ministries of Health USAID Maternal, Newborn and Child Health Integrated Program (MCHIP) Academy of Pediatrics (AAP) Laerdal Foundation for Acute Medicine