Strengthening maternal and newborn health in rural Ethiopia: Early results from frontline health worker community maternal and newborn health training

  • Midwifery, Volume 29, No. 3, Year 2013

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Study Justification:
– The study aims to describe the early results of the Community Maternal and Newborn Health (CMNH) training program in rural Ethiopia.
– The objective is to improve maternal and newborn health in areas with limited access to health facilities.
– The study assesses the transfer of knowledge and skills from CMNH Master Trainers to Health Extension Workers (HEWs) and Guide Team members.
Highlights:
– Post-training performance scores were significantly higher than pre-training scores in both Amhara and Oromiya regions.
– Average scores for HEWs and Guide Team members increased by over 250% and 300% for Prevent Problems before Baby is Born, and over 300% and 400% for Prevent Problems after Baby is Born.
– The CMNH program successfully transferred knowledge to HEWs and Guide Team members at the community level.
Recommendations:
– Nest the CMNH program within an enabling environment created through behavior change communication to increase demand for CMNH services.
– Emphasize evidence-based maternal and newborn care practices.
– Promote teamwork among frontline health workers.
– Enhance the role of HEWs in providing safe care during pregnancy, birth, and the early postnatal period.
Key Role Players:
– Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) project
– Community Maternal and Newborn Health (CMNH) Master Trainers
– Health Extension Workers (HEWs)
– Guide Team members (including Traditional Birth Attendants and volunteer Community Health Promoters)
Cost Items for Planning Recommendations:
– Training materials and resources
– Communication and behavior change campaigns
– Support for HEWs and Guide Team members
– Monitoring and evaluation systems
– Infrastructure improvements (if necessary)
– Coordination and management costs

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study employed a non-experimental, descriptive design to assess training implementation in six rural districts of Ethiopia. Performance testing was conducted to assess the transfer of knowledge and skills. Post-training performance scores were significantly higher than pre-training scores. However, the abstract does not provide specific details about the methodology or the statistical analysis used. To improve the evidence, the abstract could include more information about the study design, sample size, and statistical tests used. Additionally, providing more specific results and discussing any limitations of the study would further strengthen the evidence.

Objective: to describe early results from the Community Maternal and Newborn Health (CMNH) training programme of the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) project. Design: a non-experimental, descriptive design was employed to assess training implementation. Setting: six rural districts of Amhara and Oromiya regions, Ethiopia. Participants: 91 Health Extension Workers (HEWs) and 626 Guide Team members including Traditional Birth Attendants (TBAs) and volunteer Community Health Promoters (vCHPs). Intervention: CMNH is one aspect of a broader strategy to improve maternal and newborn health at the community level in rural areas of Ethiopia where pregnant women have limited access to health facilities. Measurements: performance testing of HEWs, TBAs, and vCHPs was conducted to assess transfer of knowledge and skills from CMNH Master Trainer level to CMNH Trainer level, and from CMNH Trainer level to CMNH Guide Team (GT) level on the topic areas of Prevent Problems before Baby is Born and Prevent Problems after Baby is Born. Findings: post-training performance scores were significantly higher than immediate pre-training scores for Amhara and Oromiya regions on both topic areas (p<0.001). For HEWs and GT members, respectively, average scores increased over 250% and 300% for Prevent Problems before Baby is Born, and over 300% and 400% for Prevent Problems after Baby is Born. Key conclusions: CMNH was successful in transferring knoweldge to HEWs at the CMNH Trainer level and to Guide Team members at the community level. In order for gains to be realised and sustained, the CMNH programme will be nested within an enabling environment created through behaviour change communication to increase demand for CMNH services, emphasising evidence-based maternal and newborn care practices, teamwork among frontline health workers, and an enhanced role of HEWs in provision of safe care during pregnancy, birth, and the early postnatal period. © 2012 Elsevier Ltd.

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The recommendation from the study is to implement the Community Maternal and Newborn Health (CMNH) training program in rural areas of Ethiopia to improve access to maternal health. The program aims to transfer knowledge and skills to Health Extension Workers (HEWs), Traditional Birth Attendants (TBAs), and volunteer Community Health Promoters (vCHPs) in order to prevent problems before and after childbirth. The study found that post-training performance scores significantly increased compared to pre-training scores, indicating the effectiveness of the program. To ensure the sustainability of the gains, the CMNH program should be integrated into an enabling environment that includes behavior change communication to increase demand for CMNH services, promote evidence-based maternal and newborn care practices, encourage teamwork among frontline health workers, and enhance the role of HEWs in providing safe care during pregnancy, birth, and the early postnatal period.
AI Innovations Description
The recommendation from the study is to implement the Community Maternal and Newborn Health (CMNH) training program in rural areas of Ethiopia to improve access to maternal health. The program aims to transfer knowledge and skills to Health Extension Workers (HEWs), Traditional Birth Attendants (TBAs), and volunteer Community Health Promoters (vCHPs) in order to prevent problems before and after childbirth. The study found that post-training performance scores significantly increased compared to pre-training scores, indicating the effectiveness of the program. To ensure the sustainability of the gains, the CMNH program should be integrated into an enabling environment that includes behavior change communication to increase demand for CMNH services, promote evidence-based maternal and newborn care practices, encourage teamwork among frontline health workers, and enhance the role of HEWs in providing safe care during pregnancy, birth, and the early postnatal period.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a potential methodology could involve the following steps:

1. Selection of study sites: Choose rural areas in Ethiopia where access to maternal health services is limited. These areas should have a sufficient number of Health Extension Workers (HEWs), Traditional Birth Attendants (TBAs), and volunteer Community Health Promoters (vCHPs) who can participate in the training program.

2. Baseline assessment: Conduct a baseline assessment to measure the current knowledge and skills of HEWs, TBAs, and vCHPs in the selected study sites. This assessment will provide a benchmark against which the impact of the training program can be measured.

3. Implementation of the CMNH training program: Implement the Community Maternal and Newborn Health (CMNH) training program in the selected study sites. The training program should focus on transferring knowledge and skills to HEWs, TBAs, and vCHPs, with an emphasis on preventing problems before and after childbirth.

4. Post-training assessment: After the completion of the training program, conduct a post-training assessment to measure the knowledge and skills acquired by the participants. This assessment should use the same measurement tools as the baseline assessment to ensure consistency.

5. Data analysis: Analyze the data collected from the baseline and post-training assessments to compare the pre-training and post-training performance scores of the participants. Use statistical methods to determine if there is a significant increase in performance scores after the training program.

6. Enabling environment integration: Integrate the CMNH program into an enabling environment that includes behavior change communication strategies to increase demand for CMNH services, promote evidence-based maternal and newborn care practices, encourage teamwork among frontline health workers, and enhance the role of HEWs in providing safe care during pregnancy, birth, and the early postnatal period.

7. Monitoring and evaluation: Continuously monitor and evaluate the implementation of the CMNH program in the study sites. Assess the sustainability of the gains achieved through the program and make any necessary adjustments to ensure its long-term impact on improving access to maternal health.

8. Reporting and dissemination: Prepare a comprehensive report summarizing the methodology, findings, and recommendations of the study. Disseminate the findings to relevant stakeholders, including policymakers, healthcare providers, and organizations working in maternal health, to inform future interventions and programs.

By following this methodology, researchers can simulate the impact of implementing the CMNH training program and its integration into an enabling environment on improving access to maternal health in rural areas of Ethiopia.

Statistics:
Citations: 28
Authors: 8
Identifiers:
DOI: 10.1016/j.midw.2012.01.006
ISSN: 02666138
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health
Study Countries:
Ethiopia
Study Design:
Cross Sectional Study, randomised-control-trial
Participants Gender:
Female
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