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Training of Trainers Creates Cascade Effect of Knowledge and Skill

Eden Ahmed Mdluli, M.P.H, PMP, Project HOPE’s Senior Program Officer, RMNCH (Reproductive, Maternal, Newborn and Child Health), recently accompanied a team of experts for a National Training of Trainers on Essential Newborn Care in Sierra Leone.

In April of this year, I traveled to Sierra Leone for 12 days to support three volunteers and one consultant who are expert trainers in the field of newborn care including Dr. George Little, a renowned neonatologist and Fellow at the American Academy of Pediatrics; Dr. Yemah Bockarie, a Sierra Leonean pediatrician who works at Cape Coast Teaching Hospital in Ghana; and Beryl Brooks, our 2016 Volunteer of the Year).

• Sierra Leone has the highest maternal mortality ratio in the world.
• Newborn mortality and stillborn rates are alarmingly high.
• Eighty percent of all newborn deaths in Sierra Leone are caused by preterm birth, intra-partum related causes and newborn sepsis.

This dire situation was exacerbated by the Ebola Virus Disease outbreak, which led to the death of 221 health care workers further complicating access to services.

Project HOPE is working in close collaboration and coordination with officials from the Ministry of Health and Sanitation (MOHS), United Nations agencies, District Health Management Teams, other NGOs and local councils to strengthen Sierra Leone’s health system to provide quality care for women, newborns and adolescents.

The team of expert trainers and staff traveled to Sierra Leone upon the request of MOHS to train 30 national master trainers in Essential Newborn Care. They subsequently supervised the 30 master trainers train 250 district trainers in four districts including in Freetown and Bo – all within a period of less than three weeks. The training followed the American Academy of Pediatrics and WHO guidelines and materials such as Helping Babies Breathe and Essential Care for Every Baby. It emphasized mastery of neonatal resuscitation skills and taught other trainers how to teach using interactive simulations and demonstrations.

The Project HOPE team greatly assisted the Ministry and partners in improving materials for the training of trainers as well as the subsequent cascade of training to service providers at the peripheral or primary health units.

Under the MOHS plan and guidance, the trained district trainers will pass on their training to labor and delivery staff at the peripheral units. This is the cascade effect – where lifesaving knowledge is successively passed along from the trained national master trainers to district level trainers who will later train non-hospital level MNCH providers.

This training is expected to greatly improve lifesaving care for each newborn through:

• Improved routine and essential care
• identification of danger signs requiring referral to a higher level facility
• and defining the steps needed to make referrals

It is clear there is a desire for expert training in newborn care among the health care workings in Sierra Leone. Participants were very engaged and came to all four days of the training, even though it was the start of the Easter holiday weekend. Many of the participants were already experienced trainers so their comfort with the role of the trainer was apparent. By and large, they seemed enthusiastic about the new model of training using our small group, highly interactive approach. Because availability of training mannequins (NeoNatalies) was not always adequate to support the number of trainees, Project HOPE provided additional NeoNatalies at each training site. Mastery of neonatal resuscitation skills was emphasized, as well as the skill of leaving the cord intact for one to three minutes. Adequate documentation of a newborn’s condition and documentation during referral for higher care was reinforced. A lack of essential commodities were noted in all of the District Trainings including Injection Vitamin K, Tetracycline Eye Ointment and Ampicillin.

There were many robust discussions after each session on cultural practices that affected essential newborn care activities including breastfeeding and cord care. MOHS plans to cascade this training to the primary health care providers in the coming months using the 250 trained trainers in settings such as health care centers and maternal and child health posts.

After the government’s commitment to the training, supportive supervision and mentorship follow up is essential to be successful. While many health professionals benefitted from The Essential Newborn Care training, this was only the first training of trainers that need to happen to improve the outcome of care.