Step 3: Prepare Providers to Deliver Care
Ensuring that health care providers have adequate knowledge and skills improves the quality of the entire health care system.
Develop clinical champions for PPH interventions: To change clinical practices and attitudes, it is helpful to have clinical leaders at the facility level who are convinced of the evidence and can persuasively convince their peers during the implementation process.
Conduct a training needs assessment: Although most low and middle income countries have been working to reduce maternal mortality through strengthening SBA, BEmONC and CEmONC training, a systematic training needs assessment for all relevant PPH interventions and all types of providers can be useful to prioritize remaining gaps in the training system.
Disseminate simple and adapted job aids during training: Job aids can greatly assist providers in transferring learning to their work site and maintaining standards of care. Job aids could include those for developing a birth preparedness plan (including speaking to the importance of giving birth with an SBA, so as to receive AMTSL), AMTSL, monitoring in the immediate postpartum, storage of uterotonics, and quantification for uterotonics (see Section 4 for available job aids).
Develop a training strategy and strengthen training sites: Based on the training needs assessment findings, any existing pre-service and/or in-service training strategy for SBA, BEmONC and CEmONC can be updated to ensure all aspects of PPH are addressed.
• Training sites may need to be assessed and strengthened to ensure classroom teaching and clinical practices appropriately teach PPH prevention and management.
• Where appropriate and possible, develop alternate training strategies, such as the site and individual (SAIN) learning approach, to reduce cost, increase effectiveness, and increase access to training activities.
• Link managers, pharmacists and clinicians to ensure that supplies and drugs are available to practice AMTSL safely, thus increasing the likelihood that training is transferred to the work site.
Program Pitfalls and Lessons Learned: Human Resource Development
• Many countries have guidelines and training curricula in place supporting AMTSL within broader maternal and newborn health training initiatives. Other newer PPH interventions may not yet be included, but the effective processes from AMTSL work can be utilized.
• National priorities should focus on human resource development and include training strategies to improve the knowledge and skills of health care workers; all cadres of providers attending births need to be included in a training strategy.
• Sufficient resources are needed for training and supervision to improve provider skills, performance and quality of care (QOC).
• Competency-based and humanistic training approaches must ensure that all participants have the ability to develop clinical skills in actual clinical environments with patients. Before doing so, it is necessary to provide them with the chance to practice in simulated settings with anatomic models.
• Task-shifting to lower level cadres is essential to increasing uterotonic coverage, especially where SBAs are not available. Community-based approaches should be a priority and CHWs should be included in training plans.