Helping Mothers Survive: Bleeding After Birth

Helping  Mothers  Survive:  Bleeding  a6er  BirthAn  innova8ve  training  approach  bringing  competency-­‐based  training  to  the  frontline  to  help  mothers  survive  the  day  of  birth!

Cherrie  Lynn  Evans,  DrPH,  CNM  Senior  MNH  Advisor  

 Global  Alliance  for  Nursing  and  

Midwifery  February  2014    

Today’s Agenda!

!  What is “Helping Mothers Survive”?!

!  Why do we need another training?!

!  The evidence for this training style!

!  Development and testing!!  Ongoing practice is key!!!  Where it is being used!!  How to get involved!!  Resources!

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What  is  Helping  Mothers  Survive?  

!  Series of modules on leading killers!1st Bleeding after Birth!

!  Similar in look and feel to Helping Babies Breathe!

!  Facility based training and practice"

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•  One-­‐day  training  •  Onsite  •  Hands-­‐on  learning  •  Simula4on  •  Scenario  prac4ce  •  Highly  graphic  materials  

Why  do  we  need  this?  

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Helping Mothers Survive:"

Bleeding after Birth"

Why  do  we  need  this?  

!  AMTSL – Uterotonic use in 3rd stage!

!  Quality of care surveys in 6 countries 2009-2011 showed that fewer than 29% of women received AMTSL to standard.!

!  Traditional training approaches don’t reach everyone!"

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Innova4ve  solu4ons  

Efficient  and  

effec4ve  

Acquisi4on  of  

knowledge  and  skills  

Change  prac4ce  

In-­‐Service  Training  

What  makes  in-­‐service  training  effec4ve?  

Technique  

Loca4on  

Timing  Media  

Loca8on  

Timing    

Media  Print  • Texts  • Job  aids  Live  

Audio/Video  

Mobile  messaging  

Computer  -­‐  Off-­‐line,  Online,  Real  4me  

Technique  Passive  •  Lecture  • Reading  

Par4cipatory  • Games  • Team-­‐based  •  Self-­‐directed  • Case-­‐based  •  Simula4on  

The  Key  Component?  

Technique  

SeSng  

Timing  Media  

We  need….  

Reading  

Lecture  

LESS    

MORE  

Simula8on  

Prac8ce      with              Feedback  

Case-­‐based  

Helping  Mothers  Survive  Stakeholders  

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Competencies    

1.  Ac8ve  Management  of  Third  Stage  of  Labor  

2.  Simplified  management  of  PPH  

Helping  Mothers  Survive  is  Highly  graphic  

Uses  Mul8disciplinary  Small  Groups  

Emphasizes  Simula8on  

Change  in  prac8ce  

Mother  and  Newborn  are  a  unit  

Train  ALL  authorized  providers  

Highly  graphic  materials  

Short  &  sweet  

Interac8ve  simulators  

Shared  facilita8on  of  prac8ce  

HMS  Training  –  Concept  

“Low  dose,    high  frequency”    

prac4ce  

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Low-Dose, High-Frequency Practice!

Definition – !Case-based scenarios!Hands on simulation!Participatory!Team-based or pairs!

!Timing – !

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Evidence for Helping Mothers Survive?!

BAB  Knowledge    Assessment:  By  Country  Average  Scores   Pass  Rate  

Pretest   Post-­‐test  

p-­‐valuea  

Pre-­‐test  

Post-­‐test  

p-­‐value  

Total   76%   89%   ***   71%   94%   ***  India  (n=47)  

70%   87%   ***   45%   89%   ***  

Malawi  (n=44)  

83%   93%   ***   100%   100%   n/a  

Zanzibar  (n=26)  

75%   87%   ***   70%   92%   *  

a  *p<.05  and  ***p<.001  

HMS  Field  Test  -­‐  Findings    25  item  test  -­‐  validated  by  60  SME  

3  skills  sta4ons  –  validated  by  60  SME  

Pass  Rate    

AMTSL  (11  items)  

Retained  Placenta    

(7  items)  

Bimanual  Uterine  Compression  (12  items)  

Total   83   89   85  

India   82   88   90  

Malawi   83   90   79  

HMS  Field  Test  -­‐  Findings  

 Self-­‐Reported  Confidence  in  Skills*  

Before  Training  

Amer  Training  

p-­‐Value  

Providing  AMTSL   3.3   4.1   p<.001  Managing  PPH   3.1   3.9   p<.001  Performing  bimanual  uterine  compression    

2.9   4.0   p<.001    

*Likert  scale:    1  =  “I  cannot  perform  this  skill”                                                      5  =  “I  am  extremely  confident”  

HMS  Field  Test  -­‐  Findings  

Global Distribution of HMS Training!

700+ trained 48+ countries

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Saving  Lives  at  Birth  -­‐  Uganda  •  HMS  training  at  facili4es  – 8  weeks  of  prac4ce  

•  HBB  training  at  facili4es  – 8  weeks  of  prac4ce  +  4  

Pair  HMS  and  HBB  in  12  districts  and  measure  health  outcomes  of  

mothers  and  babies  

Where next?!

!  ICM!!  FIGO!!  UNFPA!!  UNICEF!!  Faith based organizations!!  Academic institutions!!  Ministries of Health!!  Professional bodies!!

How can you get involved?!

Learn more!www.helpingmotherssurvive.org!!

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How to Become a Helping Mothers Survive Trainer!

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Write  us  at:  

[email protected]    

Thank you!!

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