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Methods: The study was implemented in 12 districts in two regions of Uganda. The districts in each region were divided into three study arms (4 districts per arm). Each study arm received different interventions. The control arm received training only, the partial arm received training and Clinical Mentors (CMs) support, and the full arm received a combination of training, CMs and mobile phone support. CMs mobilized and facilitated onsite practice sessions for 10-15 minutes each week based on the pre-designed schedule. After one day training, all facilities were left with the birthing simulators (MamaNatalie and Neonatalie), practice session schedules and guides, and practice logs. All providers that attended or assisted during birth were expected to simulate different scenarios for 20 weeks.
Results:
Providers in full and partial arms that had clinical mentors (CMs) practiced more than four sessions after the day of training compared to those in control arm. After HMS training, 24% of providers in full arm practiced and practice sessions increased to 59% after HBB training. 27% in partial arm practiced post HMS and increased to 58% post HBB training. In control arm, only 10% and 12% of providers practiced for HMS and HBB respectively. There was also a noticeable difference in providers’ performance of different tasks from baseline to midline among those that had and those that did not have CMs and did not practice. The percentage of providers that washed hands with soap or an alcohol rub statistically significantly increased from 35% to 58% (P<0.001) in facilities that had CMs and those that did not from 35% to 47% (P=0.044). Preparing a drug for AMTSL increased from 77 % to 93% in clinical mentorship facilities and there was no improvement in facilities that did not have (79% baseline to 79% midline).The percentage of providers that gave a uterotonic within five minutes of birth increased from 77% at baseline to 95% (P<0.001) at midline in mentored facilities and increased from 59% to 68% (P=0.113) in non-clinical mentored. Although there were statistically significant improvements in some indicators across both facility types, facilities with CMs performed better than those without. The percentage of providers that gave a uterotonic within one minute of birth increased from 11 to 24% (P<0.004) and 16-34% (p<0.0001) among facilities that did not have CMs and those that had respectively. The percentage of providers that placed the baby on the abdomen skin to skin of the mother increased from 34% at baseline to 55% at midline and 33% to 61% among those providers without and those that had CMs respectively. The percentage of providers that encouraged the mother to breastfeed within an hour of birth increased from 13% at baseline to 53% at midline and from 30-70% in facilities that had no CMs and those with a CM respectively.
Conclusion: Peer led practice sessions should be underscored because of the enormous benefits. Presence of a clinical mentor at the facility increased chances of health providers to practice different scenarios using the birthing simulators. This increased providers’ competencies to perform different tasks related to the care of the baby and the mother during birth thereby increasing their chances of survival. This approach to training is a very practical way to achieving both learning and patient care especially in a human resources for health constrained environments in Uganda.