Helping Mothers Survive and Helping Babies Breathe: Nurse-Midwives Bringing High Impact Interventions to Low-Resource Settings

Chace, Sara A.

Building on the success of Helping Babies Breathe (HBB), Helping Mothers Survive (HMS) is an innovative training initiative to equip nurses, midwives, and other frontline workers with the knowledge and skills required to prevent mothers dying from preventable causes on the day of birth. Both HMS and HBB are simulation-based training packages for providers working in countries with a high burden of maternal and newborn mortality. These packages complement and extend the reach of basic emergency obstetric and newborn care (BEmONC) training by acting as the “booster shot” to the initial “immunization” of BEmONC; however, they can also be used in settings where BEmONC has not been used. All training modules are grounded in evidence that shows health workers better retain clinical skills through simulation using anatomic models and case-based learning opportunities. Benefits to this training approach include reaching a higher number and a greater range of health workers, bringing technical updates to hard-to-reach urban and rural communities where it is most needed, promoting teamwork, providing immediate feedback on performance, and keeping needed human resources on-site.

Countries in francophone Africa have some of the highest maternal and infant mortality rates; Mauritania is an example with a Maternal Mortality Rate of 602 and an Infant Mortality Rate of 63. Knowing that the same provider who cares for a woman at birth is also responsible for the care of her new-born, we combined the two approaches to provide a high-impact intervention for this region. In 2015, five global agencies, including Jhpiego, UNFPA, French Red Cross, Laerdal Global Health, and AMREF, partnered in Dakar, Senegal to host a 6-day HMS and HBB workshop for program advocacy and implementation in nine francophone countries. With an overall goal to train and equip all providers who care for women at birth with essential knowledge and skills to address the postpartum haemorrhage and birth asphyxia and improve quality of care, the workshop accomplished the following:

An advocacy and planning retreat for high-level government representatives from each country.
Design of work plans led by country teams for scale up of HMS and HBB training in their countries.
Implementation guidance at the workshop and after to support country-based activities for scale up.

Within 6 months of the workshop, and with only 2 Master Trainers for each country, participants from the Dakar workshop have rolled out this innovative, combined training program in their countries. As the training is implemented onsite, and encourages peer-to-peer learning after the inital training dose, each country program has been able to integrate HMS and HBB into exisiting health programs with relatively low investment costs, specifically in Mauritania, and Niger. While the Master Trainers in Dakar, Senegal were a mix of doctors and midwives, roll-out in country, training, and sustained practice after the initial content dose has been lead by local mid-wives and nurses. Progress to date includes the training and mentorhip of eight midwives, who then trained providers caring for women and their newborns in HMS and HBB from 28 health centers in the Gorgol district in Mauritania. In Niger, a regional training in the Zinder district resulted in 13 Master Trainers and 37 Champions for further roll-out at the facility-level and integration into pre-service. In Burkina Faso and Senegal, programmers have begun the procurement process for simulators and learning materials and conducted advocacy trainings at the ministry-level for subsquent roll out. Haiti has trained 19 providers in HBB at 3 health centers and is working to incoperate HMS and HBB into midwifery training curriculum. In Chad, trainers were trained in HMS and HBB and will continue to roll-out to midwives and their supervisors on both programs in 15 health centers and 2 hospitals. Mali has a HBB program and will begin integrating a combined program of HMS and HBB in 2016.