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Background: In 2010, the Federal Ministry of Health of Ethiopia (FMOH) has developed standard Basic Emergency Obstetric and Neonatal Care (BEmONC) in-service training curricula to respond to the high demand for competency in EmONC. However, the effectiveness of the training curricula has not been well documented. A collaborative intervention project in Addis Ababa has trained providers using the standard BEmONC curricula where this paper presents Krikpartick level 1 and level 2 evaluation of the training.
Addis Ababa, the capital of Ethiopia is administratively divided into 10 sub-cities. Of the over 3.5 million people living in the city, about 70% are mothers and children. Over 70 public HCs and five public hospitals under the Addis Ababa City Administration Health Bureau are offering maternal and child health care to the majority of the city dwellers. All the public HCs are primary care units and are the first contact point in the continuum of maternal and newborn health care. These HCs are also providing BEmONC, while all the public hospitals provide comprehensive EmONC. A referral network has established from the public HCs to the hospitals for mothers and babies who are requiring advanced interventions. This study was part of the collaborative intervention project in Addis Ababa. The project has got ethical approval from the Addis Ababa City Administration Health Bureau Ethics Committee and by the regional Ethics committee in West Norway. Study permits were obtained from the Addis Ababa City Administration Health Burea, the health bureaus of the 10 sub-cities and from the project HCs. The main objective of the project is to improve the quality of basic EmONC in Addis Ababa and to ensure equitable access. For improving quality, intensive hands on skills training using low cost and low tech simulators (MamNatalie and NeoNatalie) were provided. For bridging the equity gaps, the project targeted public HC where the majority of poor and disadvantaged women are accessing EmONC services. Of the 24 HC providing delivery care services in the city, ten HC one from each sub city was randomly selected for the project. There were 89 midwives and nurses who were working in the delivery wards of the project HCs. Of these eligible providers, seven did not receive the training (One for social reason while the rest had already received the training recently). Eighty two providers received the standard BEmONC training in four rounds where each round of the training took three weeks in accordance with the standard set by the FMOH [9] (Figure 1). The Ethiopian Midwifery Association having vast experiences in implementing the standard BEmONC training across the country conducted the training under close supervision of the project leader and project team members. Study flow chart. The first eight days of the training were classroom theoretical sessions complemented with demonstration, videos, case studies and role plays. The last ten days were for the skills training using demonstrations and clinical sessions until trainees achieve mastery in selected skills with checklist based evaluations. Prior to the start of the course, pre-course assessment was done to identify knowledge gaps among trainees on the management of shock, bleeding before and after birth, normal labour, third stage of labour, pre-eclampsia/eclampsia, partograph use, puerperal sepsis and on neonatal resuscitation. By the end of the theoretical sessions, there was an immediate post-course evaluation to assess knowledge-based mastery using a tool that contained 36 multiple-choice questions on nine major topics; 1) infection prevention practices, 2) vaginal bleeding in early pregnancy, 3) rapid initial assessment and management of shock, 4) childbirth care, 5) unsatisfactory progress of labour, 6) mal-presentation and malposition, 6) headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure, 7) vaginal bleeding after child birth, 8) fever and 9) new born care. Trainees who answered 31 questions correctly out of the 36 or those who scored ≥85% were considered to have achieved knowledge-based mastery according to the standard BEmONC training curriculum [9]. Trainees who failed to achieve knowledge-based mastery in the first attempt sat for re-exam until they recorded mastery. However, this paper presents the knowledge-based mastery recorded in their first attempt. Six-month post training 74 (90.2%) providers participated in a knowledge retention evaluation (Figure 1). All the providers were approached in their respective workplace to fill out the same tool that was used to assess the knowledge-based mastery during the immediate post-course. The aim of this evaluation was to assess knowledge retention six months after the training. By the end of the third week of the training, trainees were asked to evaluate the course in eight major areas in a scale ranging from strongly disagree to strongly agree. Assessed topics included 1) For the work I do, the training was appropriate 2) Training facilities & arrangements were satisfactory 3) The facilitators were knowledgeable & skilled 4) The facilitators were fair and friendly 5) Training objectives were met 6) The training was updating my knowledge & skills 7) Teaching aids were useful and 8) Practice in the clinical areas was important & helpful. The findings are presented in percentages, mean, standard deviation and student t-tests.
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