Service Provision Training
Midwifery and Obstetric First Aid Refresher Training
for Maternal and Child Health Workers
Maternal and Child Health Workers (MCHWs) are the frontline
providers of everyday midwifery care and obstetric first
aid in communities of 4,000-5,000 people. In response to
this, the Nepal Safer Motherhood Project (NSMP) supports
a six-week competency-based training course specifically
on midwifery and obstetric first aid. This focuses on the
management of major obstetric complications and helps MCHWs to
increase their competence and confidence in providing services.
After refresher training, each MCHWs is
given an emergency obstetric care (EmOC) kit. This enables
them to provide maternity services and obstetric first-aid
or to refer women to the nearest facility for basic or
comprehensive essential obstetric care (BEOC/CEOC).
All MCHWs attend
semi-annual review and planning workshops at the district
health office. These are supported by NSMP and
enable the MCHWs to
review their performance and plan for the next six months.
Any technical problems are discussed and clarified by the MCHWs trainer
or district Public Health Nurse, while any issues relating
to service delivery are discussed and addressed using district
and local level efforts.
After refresher training, MCHWs show
increased motivation and confidence in delivering services and
are appreciated by the community as skilled service providers. NSMP also supports efforts to create an enabling environment
for MCHWs in
sub-health posts (ie at community level) in order to allow them
to make optimum use of new skills.
Refresher Midwifery and Obstetric Care Training
for mid level and senior Nurses
The Refresher Midwifery training
Care course is carried out in the hospitals of United Mission
to Nepal - Patan and Tansen. It lasts 30 days, is competency-based
and aims to improve the ability of nurses to provide quality
midwifery and obstetric care as outlined in the national
reproductive health clinical protocols. The course has
resulted in a much-appreciated expanded role for nurses and in
the institutionalising of evidenced-based midwifery and obstetric
care at the hospitals. It has been complemented by NSMP also
helping to provide maternity wards with equipment, essential supplies
and drugs. Together, these developments have helped to increase
both the confidence of nurses and the quality of midwifery and
obstetric care that they provide. The course has also motivated
the participants to share their new skills with other nursing staff
and nursing students.
Post Basic Midwifery Course
for Senior Nurses
In accordance with the National SMP (Safe Motherhood
Plan) goal in 1997 a ten month post basic (diploma) midwifery
course was designed with the aim of developing staff nurses' skills
in providing quality midwifery care, a full range of BEOC services,
and give them an understanding of safe motherhood issues cross
sectorally. The course was approved by His Majesty's Government
of Nepal (HMGN) in 1999 and its development and subsequent implementation
has to date been supported by NSMP.
The graduates are posted to
hospitals and Primary Health Care Clinics (PHCC) . Following
the training, NSMP has
supported graduates in three districts in terms of ensuring basic
equipment and instruments are available.
The graduate's role and responsibilities
are as follows:
- Provide care to women during pregnancy, labour
and post partum period
- Conduct delivery and provide care to newborn
- Educate pregnant women and their families on dangerous
- Counsel them on when and where to seek
- Detect abnormal conditions in mother or child
- Provides obstetric
first aid and BEOC to
those women who present themselves with major obstetric complications
2001, a Ministry of Health (MOH) team evaluated the course and
the findings suggested that all eleven graduates were able to provide
midwifery care. However, they have still to develop full confidence
in managing complications within the boundaries set by the clinical
protocols although this is more likely to be due to constraints
in their working environment than in course limitations. They are
clearly proud to call themselves Nepal's midwives, not only in
accordance with their skill level but also as a result of their
increased profile in their communities and their enhanced leadership
qualities. The graduates appreciate the broad underlying factors
(such as poverty and women's education levels) that affect maternal
health in Nepal and are addressing these areas in addition to their
health-related responsibilities. The team believe that the "added value" that
midwives bring to the challenge of reducing maternal mortality
is their ability to view and act for safe motherhood cross sectorally,
the ability to influence other cadres of staff, and the ability
to engage with communities who respect their skills.
Obstetric Care (BEOC) Training for Doctors and Nurses
was first run in February 2002 and is already in great demand.
Participants greatly valued the course and gained a sense of
empowerment in being able to save women's lives. The training not
only enhanced their clinical skills, but has proved to motivate
trainees to share their skills with nursing staff and medical officers
in neighbouring district hospitals.
This training package was developed
using international reference material and the IMPAC EOC package
developed by JHPIEGO/AMDD.
There are few anaesthetists
in Nepal, particularly at zonal and district hospital levels.
For this reason, a four-month Anaesthetic Assistant Training course
was piloted in 2002 and run at the Western Regional Hospital,
Pokhara, with the support of International Nepal Fellowship (INF),
National Health Training Centre (NHTC) and Family Health Division
(FHD). After an evaluation,
the course was extended to six months and formally approved by
the NHTC and FHD. It is now the nationally approved course for
paramedics and nurses.
have now established Comprehensive Essential Obstetric Care (CEOC)
services in most of their hospitals and are offering safe and
reliable anaesthetic services under the supervision of Medical
Doctor General Practitioners (MDGPs). In turn, MDGPs are demonstrating
greater confidence in the management of patients with serious conditions.
Care (PAC) Training for Nurses and Doctors
Nurses and doctors
from the project's districts have received training in Post-Abortion
Care (PAC) in order to be able to offer 24-hour BEOC services
in appropriate health facilities. The training was developed with
the support of JHPIEGO.
Aid Training for Paramedics
This course is designed to encourage
Area Health Workers (AHWs) to provide support to their MCHWs to enable them to treat or refer women
appropriately and in time. It runs for five days and is designed
and conducted at district hospital level, with the participation
of local nurses and doctors.