Two hundred and ninety-nine participants completed the study out of the original 323 providers who were randomized to different study arms; LDHF arm = 172; TRAD arm = 127 (Table 1 and Fig. 1). Both arms had similar socio-demographic characteristics Table 1).
Table 1
Baseline characteristics of study sample of providers by study arm
Characteristic of Health Workers | LDHF/m-mentoring | TRAD | |
N = 172, Percent | N = 127, Percent | p value |
State or Location |
Ebonyi | 36.6 | 26.0 | 0.05a |
Kogi | 63.4 | 74.0 |
Type of Facility |
Primary health center | 38.4 | 47.2 | 0.05a |
General/Mission hospital | 52.3 | 38.6 |
Tertiary hospital | 9.3 | 14.2 |
|
Mean (SD) Age: years | 41.0 (10.3) | 40.6 (8.8) | 0.78b |
|
Sex |
Male | 15.7 | 22.0 | 0.16a |
Female | 84.3 | 78.0 |
Marital Status |
Married | 84.3 | 89.0 | 0.60c |
Single | 10.4 | 8.6 |
Divorced | 0.6 | 0.0 |
Widowed | 4.7 | 2.4 |
Religion |
Christian | 79.7 | 74.8 | 0.33a |
Islam | 18.6 | 22.8 |
Other | 0.0 | 0.8 |
Missing | 1.7 | 1.6 |
|
Duration Since Graduation: years | 12.0 (6.0–23.0) | 14.0 (8.0–21.0) | 0.54d |
|
Cadre/Job Title | | | |
Community health extension worker | 34.3 | 43.3 | 0.03c |
Doctor | 3.5 | 8.7 |
Nurse | 57.0 | 46.4 |
Other | 5.2 | 1.6 |
|
Median (IQR) Duration Working at Facility since Employment: years | 6.0 (3.0–10.0) | 6.0 (3.0–10.0) | 0.84d |
|
Median (IQR)* Time to Training: minutes | 60.0 (60.0–90.0) | 60.0 (60.0–120.0) | < 0.001d |
|
Duration at current position: median (IQR) years | 8.0 (4.0–18.0) | 9.0 (4.0–15.0) | 0.76d |
Types of tests: a = Pearson's chi-squared; b = Two sample t test; c = Fisher's exact; d = Wilcoxon rank-sum. SD, standard deviation; IQR, interquartile range. *TRAD participants residing within 5 km of the training sites were not accommodated in a hotel; they travelled daily to the training site. |
Table 2 shows that the TRAD arm had better knowledge test scores compared to the LDHF/m-mentoring arm at baseline and immediately after the training intervention in some thematic areas, such as AMTSL, essential newborn care, and neonatal resuscitation (p < 0.05). However, at 3 and 12 months after training assessment, both arms are equal in knowledge acquisition and retention; no statistically significant differences were noted.
Table 2
Comparison of levels of knowledge between study arms across four assessment periods
Thematic Area # | Thematic Area | Total number of items | Assessment 1—Baseline | | |
| | Unadjusted analysis | Adjusted analysis* |
Mean # correct, LDHF | Mean # correct, TRAD | IRR (95%CI) | p value | IRR (95%CI) | p value |
1 | Infection prevention | 6 | 3.17 | 2.67 | 1.19 (1.07, 1.32) | 0.001 | 1.17 (1.06, 1.30) | 0.002 |
2 | Normal birth | 8 | 4.17 | 4.01 | 1.04 (0.96, 1.13) | 0.349 | 1.03 (0.95, 1.12) | 0.498 |
3 | AMTSL | 4 | 1.79 | 1.73 | 1.03 (0.88, 1.21) | 0.682 | 1.02 (0.88, 1.18) | 0.822 |
4 | Management of eclampsia | 2 | 1.13 | 1.11 | 1.02 (0.89, 1.18) | 0.754 | 1.02 (0.88, 1.17) | 0.805 |
5 | Essential newborn care | 2 | 0.94 | 1.03 | .92 (0.77, 1.09) | 0.318 | 0.91 (0.76, 1.08) | 0.270 |
6 | Neonatal resuscitation | 20 | 8.55 | 11.15 | 0.77 (0.70, 0.84) | < 0.001 | 0.75 (0.68, 0.82) | < 0.001 |
| Overall score | 42 | 17.62 | 19.71 | 0.89 (0.83, 0.96) | 0.002 | 0.88 (0.82, 0.94) | < 0.001 |
Thematic Area # | | Total number of items | Assessment 2—Immediate post-training | | |
| | | Unadjusted analysis | Adjusted analysis* |
Thematic Area | Mean # correct, LDHF | Mean # correct, TRAD | IRR (95%CI) | p value | IRR (95%CI) | p value |
1 | Infection prevention | 6 | 5.01 | 5.04 | 1.00 (0.94, 1.06) | 0.888 | 0.98 (0.92, 1.04) | 0.470 |
2 | Normal birth | 8 | 6.51 | 6.76 | 0.96 (0.92, 1.01) | 0.134 | 0.95 (0.90, 1.00) | 0.040 |
3 | AMTSL | 4 | 3.2 | 3.49 | .92 (0.86, 0.98) | 0.009 | 0.90 (0.84, 0.96) | 0.002 |
4 | Management of eclampsia | 2 | 1.72 | 1.8 | 0.95 (0.89, 1.02) | 0.138 | 0.95 (0.89, 1.01) | 0.116 |
5 | Essential newborn care | 2 | 1.34 | 1.65 | 0.81 (0.74, 0.89) | < 0.001 | 0.80 (0.72, 0.88) | < 0.001 |
6 | Neonatal resuscitation | 20 | 11.29 | 16.21 | 0.7 (0.63, 0.77) | < 0.001 | 0.68 (0.61, 0.75) | < 0.001 |
| Overall score | 42 | 24.21 | 30.57 | 0.79 (0.75, 0.84) | < 0.001 | 0.77 (0.73, 0.82) | < 0.001 |
Thematic Area # | | Total number of items | Assessment 3—3 months post-training | | |
| | | Unadjusted analysis | Adjusted analysis* |
Thematic Area | Mean # correct, LDHF | Mean # correct, TRAD | IRR (95%CI) | p value | IRR (95%CI) | p value |
1 | Infection prevention | 6 | 4.54 | 4.24 | 1.07 (0.99, 1.16) | 0.086 | 1.04 (0.96, 1.12) | 0.348 |
2 | Normal Birth | 8 | 5.9 | 5.7 | 1.04 (0.96, 1.11) | 0.342 | 1.01 (0.94, 1.08) | 0.760 |
3 | AMTSL | 4 | 3.07 | 3.04 | 1.01 (0.92, 1.10) | 0.853 | 0.97 (0.89, 1.06) | 0.569 |
4 | Management of Eclampsia | 2 | 1.69 | 1.7 | 1.00 (0.92, 1.08) | 0.932 | 0.99 (0.91, 1.07) | 0.741 |
5 | Essential Newborn Care | 2 | 1.55 | 1.52 | 1.02 (0.91, 1.14) | 0.781 | 1.00 (0.89, 1.12) | 0.964 |
6 | Neonatal Resuscitation | 20 | 14.45 | 13.98 | 1.03 (0.96, 1.11) | 0.372 | 1.00 (0.93, 1.08) | 0.978 |
| Overall score | 42 | 27.41 | 26.37 | 1.04 (0.98, 1.10) | 0.200 | 1.01 (0.95, 1.06) | 0.796 |
Thematic Area # | | Total number of items | Assessment 4—12 months post-training | | |
| | | Unadjusted analysis | Adjusted analysis* |
Thematic Area | Mean # correct, LDHF | Mean # correct, TRAD | IRR (95%CI) | p value | IRR (95%CI) | p value |
1 | Infection prevention | 6 | 4.15 | 3.99 | 1.04 (0.95, 1.14) | 0.380 | 1.01 (0.93, 1.10) | 0.795 |
2 | Normal birth | 8 | 5.59 | 5.32 | 1.05 (0.97, 1.14) | 0.213 | 1.03 (.95, 1.11) | 0.470 |
3 | AMTSL | 4 | 2.88 | 2.89 | 1.00 (0.90, 1.10) | 0.944 | 0.96 (0.88, 1.06) | 0.426 |
4 | Management of eclampsia | 2 | 1.61 | 1.59 | 1.02 (0.93, 1.11) | 0.730 | 1.00 (0.92, 1.10) | 0.920 |
5 | Essential newborn care | 2 | 1.51 | 1.46 | 1.04 (0.93, 1.16) | 0.544 | 1.01 (0.90, 1.13) | 0.867 |
6 | Neonatal resuscitation | 20 | 13.83 | 14.02 | 0.99 (0.94, 1.04) | 0.588 | 0.95 (0.91, 1.00) | 0.036 |
| Overall score | 42 | 26.47 | 26.16 | 1.01 (0.96, 1.06) | 0.642 | 0.98 (0.94, 1.02) | 0.340 |
IRR, incidence rate ratio; CI, Confidence interval |
Health workers in both arms showed improvement in overall pass rates in clinical skills competency, improving from around 30% at baseline to 75% and above at endline; difference-in-differences were statistically significant (p < 0.05); TRAD (from 27.4–74.8%) and LDHF/m-mentoring (from 30.1–81.1%). Overall, the observed improvement and retention of BEmONC skills was higher in LDHF/m-mentoring study arm participants (81.1%) compared to the TRAD arm participants (74.8%) at 12 months post-training (p < 0.05). There was a dip in both arms at the three-month assessment. (Fig. 2).
Figure 3 shows that overall for BEmONC skills, the LDHF/m-mentoring arms had better post-training assessment scores at 12 months post-training for assisting normal birth (including care of the newborn), AMTSL, manual removal of placenta, bimanual compression of the uterus, abdominal aortic compression, pre-eclampsia/eclampsia management (p < 0.05).
The results of the qualitative study are presented in four sections. The first section addressed knowledge and skill learning outcomes of birth attendants following simulation-based LDHF/m-Mentoring, the second section addressed trainees’ satisfaction with successful outcomes following simulation-based LDHF/m-Mentoring approach, third section addressed facilitators of LDHF/m-Mentoring approach and the fourth section addressed the barriers to LDHF/m-Mentoring approach (Table 3).
Table 3
Key findings by themes and supporting quotations
Key Findings | | Supporting quotation |
Theme 1: Knowledge and skill learning outcomes of birth attendants A. Knowledge on hygiene refers to improved skill or knowledge in hygienic practices e.g hand washing, proper cord care. B. Proper documentation refers to improved skill/knowledge in documentation e.g use of partograph C. Respectful maternity care refers to improved skill/knowledge in patient midwife relationship, asking patients for their opinion/choices during service delivery, speaking nicely to clients/patients instead of shouting, explaining procedures to patients/clients and asking for consent. Also allowing relatives into delivery/treatment suite if patient wishes so. D. Resuscitation includes improved/newly acquired skill/knowledge in neonatal care immediately after delivery. E. Disease management is improved skills/knowledge in managing morbid conditions, including providing initial primary care before the arrival of the doctor or referral. F. Coaching/mentoring pertains to improved skill/knowledge which has led to training other colleague or students G. Drug usage pertaining to gained improvement in skills/knowledge involving correct application of drugs for conditions identified. | A discussant in Ebonyi said: ‘Before we normally use glove as a protective device but now we wash before wearing the gloves (FGD, Ebonyi). Another respondent in Kogi said: ‘My facility re-oriented the people that work with me what standard practice is about. Example, hand washing was not practiced in my labour’. We used an improvised water in order to still be able to comply with this standard practice of hand washing even though there are no running tap (FGD, Kogi). An FGD participant in Ebonyi said: ‘The training was different to me by emphasizing that the partograph is a medico-legal document The training endured me to the use of partograph and the importance of documentation. They have started using partograph. Before now, they were not using partograph’ (FGD, Ebonyi) Also, in Kogi state, a discussant said: I was not used to making use of partograph before this training. But now, we routinely use partograph to monitor the progress of labour (FGD, Kogi). In Ebonyi, a discussant said: The respectful maternity care asking and telling the patient what you want to do and how you are going to do and the effect. Now when a woman is coming for antenatal or maternity, we ask them to come with their husbands. There were some words that we never thought were abusive but after the training, I cannot tolerate anybody abusing my patient. We now ask for patient’s opinion on how she is to be taken care of like lying down or sitting up. Unlike before you just keep commanding the patient on what to do. The training is good Another in Kogi said: ‘Yes, it had made me to reemphasize rights of patience and give them utmost respect. Value their opinion more’. Respondents in Ebonyi said: 1) ‘Mine is in neo-natal resuscitation, before if a baby is presented to me; after like I minute I will dump the baby and call another for help. But after the training, I can now resuscitate a baby no matter how bad. 2) ‘I so much value neo-natal resuscitation, now we keep the place warm and resuscitate. The baby Natalie is very helpful in the area of resuscitation before I don’t know about the breathing of the baby, but the NeoNatalie taught me’. In Kogi, respondents said: 1) “In the aspect of child resuscitation. It teaches how to resuscitate the child 2) “Now we do newborn resuscitation 1. It has provided us with options and confidence to face women with PPH unlike previously that this condition scares us a lot and usually ended in referrals. “Before we did not know of how treat eclampsia, PE, we used to refer always’ (FGD, Ebonyi). 2. What we don’t know how to handle, since we were trained we now know how to handle them e.g. handling pregnant women especially changes in their S.P. We now know hypertension, PE, E. Also bleeding (haemorrhage), before we don’t know, the training is an eye opener to us (FGD, Kogi). 3. We learnt many methods of preventing PPH. PPH is minimized here. Before I didn’t know management of PE/E. But the training helped me. Good different in knowledge in PPH, PE, E (FGD, Kogi). A respondent in Ebonyi opined: ‘The use of Mama Natalia also helps us to even teach the student nurses before using the real senario. Another said: I’ve been able to coach a colleague that didn’t part take in the training. Also students that come, I couch them. In Kogi, the participants said: 1) I like the confidence I know have resulting from the knowledge the training has helped me to gain which also made it possible for me to train others. 2) They have made me a better trainer and have taught me how to train a small group. 3) We now render correct health education in addition to sessions for in-house training sessions for staff using the guidelines, which has now been introduced. 1. ‘Also the application of magnesium sulphat in preeclampsia and clamsia. Before I didn’t understand it but now even if am sleeping, and woken up, I can perfectly handle it. It has helped to realize that misprostol is not a must for every patient. Prior to the training, I could not use magnesium sulphate but now I can. I can now make use of magnesium sulphate in handling bleeding in women the way they taught us. The training equipped us on how to manage bleeding with Oxytocin’ (FGD, Ebonyi). 2. ‘Has made a very big significant difference” like there are some areas which we don’t know before e.g. we didn’t know that this oxytocin has to be given before delivery of the placenta Ten years ago only 3 centres used magnesium sulphate and partograph in Kogi state. Presently, several facilities are making use of these’ (FGD, Kogi). |
Theme 2: Trainees’ satisfaction with successful outcomes following the simulation-based LDHF/m-Mentoring approach A. Successful outcome on maternal survival refers to numerical gains achieved following training in service delivery pertaining to reduced maternal mortality/better maternal survival following trainings and application of skills. B. Successful outcome on newborn/neonatal survival refers to successes gained as numerical improvement neonatal/infant survival, reduced neonatal/infant mortality following trainings and application of skills. C. Successful outcome on patient trust/satisfaction include any mention of gains achieved following training in service delivery involving patients/clients being happier, more co-operative, feeling safer with health workers and more trusting of health workers. | Post-partum haemorrhage and ruptured uterus are no longer occurring in the supported facilities (IDI-Kogi). ‘Less maternal and newborn complications in the supported facilities. There is clearly noticeable improved new born care and reduced complications and mortalities among new born and their mothers’ (IDI, Kogi), It has helped in reducing maternal mortality very much thus reduce the death that are related to these conditions. Firstly, since the training, we have not had maternal or neonatal deaths in our facility’ (IDI, Ebonyi). ‘Firstly, since the training, we have not had maternal or neonatal deaths in our facility. The one of the baby is my greatest success (There is one case in which a participant called me from a facility in a facility very late at night. They were having issues and she called me to clarify, it had to do with argumentation of labour. I had to put her through and by morning, she gave me the good news that all went well and the woman put to birth’ (IDI, Ebonyi)’. “Especially in newborn resuscitation. We have save babies that would have died”. Now babies can be resuscitated so more babies are surviving and we are having more successful deliveries. Before, they used to deliver people and some of the babies end up being asphyxiated. So the way there were resuscitating babies has greatly improved. But now, those problems are no more. Knowledge in method and skills of resuscitation has increased and delivery outcome improved greatly (IDI, Kogi). The training has made our clients to become confident in our ability and services as health workers, especially, after the application of respectful maternal care (IDI, Ebonyi) |
3.3 Facilitators of LDHF/m-Mentoring approach A. Support from Implementing partner refers to support or motivation for the training or practice emanating from the provision and availability of equipment, drugs or supplies from MCSP. B. Expert knowledge/skill and support from master mentors through telephone pertaining to support for training and practice through the provision of expert knowledge and skills. C. Incentives/welfare refers to support received from MCSP, master mentors or peer practice coordinators involving the provision of transport fare, lunch during practice sessions to encourage trainings/practice or reimbursement for LDHF/m-Mentoring-related phone calls. D. Support from management of facilities has to do with support provided by management involving the arrangement of duty rosters to enable trainees attend practices sessions, permission for retraining/stepping down, provision of venues/keys for practice. E. Assessments through text messages and quizzes refers to support from the mentors or coordinators which includes following up of trainees actively to ensure skills/knowledge are acquired, identifying problematic areas with correction provided. | A respondent in Ebonyi state said: They are the biggest supporter of this program, they trained us. From Kogi, respondents said: 1. ‘By bringing the training close to us. Also the knowledge they are providing me with. They trained us as consultants with them’. 2. ‘Has been supporting us through training and helping us to sharpen our skills’. From Kogi: 1. Through phone calls, I discussed topics on maternal and child health, real life experience, situation they have example PPH. I advise them to refer cases they cannot handle. 2. They support I provided on phone depended on what they ask. Sometimes while taking delivery, they may ask questions through phone on areas where they needed assistance. They will tell me what they are doing while I seized that opportunity to correct them when I realized they were not doing it right. I had taught about manual removal of retained placenta, pre-ecclampsia and ecclampsia. 3. There was once they took the picture of a baby during weighing and sent to me. I noticed the baby had cap on while weighing. I then took advantage of this to teach them how to properly take the weight measurement. From Ebonyi: Usually all the topics but mainly child resuscitation; that was the area they are not finding funny. Occasionally they call me when they have difficulty in the hospital, I also assist them. On phone, I discussed topics such as normal delivery, administration of magnesium sulphate and Manual removal of placenta. Also a mentor said, ‘I also call during their practice session since I know the time they usually have their practice session at 1.30 pm. I sometimes travel to the facilities when phone calls cannot completely address their challenges. I remind them to go back to their manual where explanation through phone is not sufficient to address their challenges’ (IDI, Kogi). ‘Salaries have not been paid for several months. So I support them financially to enable still take care of pregnancy-related matters among pregnant women. Sometimes even paying their transport. At times we pay their transport, and they stay to practice. When I visit, usually I provide refreshment to enable me get their attention. The master mentor supports through giving general encouragement on the need to comply with the guidelines and to reach him for clarification when the need arises. He also assist through training us to acquire more skills related to patient care’ (FGD, Kogi) ‘I motivate them by giving them little things (launch) just to encourage them Yes, light refreshment during practice’ (IDI, Ebonyi). ‘The management allows us to go for training’ (IDI, Ebonyi). 1. ‘Allowing us to put our new skills to practice’ (FGD,, Ebonyi):. 2. ‘They support by providing a training ground and allowing us to go for the practice’ (FGD, Birth attendants, Ebonyi). ‘They release me to go for trainings. The release gives me opportunity to learn’ (IDI, Kogi) ‘My facility: They usually release me for LDHF activities’ (FGD, Kogi). They have been supportive. At least I am here for this training because my facility management permitted me. So, they created a conducing atmosphere that permitted the project to go on successfully. Other staff also cover up for me when I am away because of this programme’ (IDI, Kogi) ‘It make us to practice. And any one we did not get right were corrected immediately’ (IDI, Kogi). |
Theme 4: Barriers to LDHF/m-Mentoring approach A. Funding/equipment/supplies pertaining to mention of problems involving inadequate funding, equipment, drugs, supplies, or electricity. B. Logistics and incessant strikes refers to problems encountered during project or use of skills in service areas pertaining to late/untimely dissemination of information, fixing of trainings while trainees are working on shift, training staff and transferring them to areas where skills are not utilized, time constraint, hectic schedule, poor/no transport, poor/wrong choice of meeting venue. C. General barriers refer to problems encountered during the project which impacted negatively on the progress of the project or the achievement of the aims/objectives. Includes all barriers outside those which have been specified in other sub-codes of barrier. | The use of the phone which requires recharge card purchases, the internet cost. Cost, initially, I was making frequent calls but later it was reduced to twice every month. I have not been paid for what I have spent so far in making calls to PPC (IDI, Ebonyi). My major challenge is electricity. It is the cost of maintaining the register because if MCSP closed, we are most likely to revert to old practice (IDI, Ebonyi) ‘We don’t always have what we need to work with and all that we need to work with. The other area is equipment. There are not enough beds, delivery consumables are not enough, oxygen, scanning machine, insufficient wards and health workers, financial barriers and lack of instruments to work with’(IDI, Kogi). ‘I find it difficult bringing everybody together at the same time because we run different shifts. It was very difficult to get members of the group to come together and practice due to our work schedule’ (IDI, Ebonyi). ‘There was the problem of so much distraction because the people were busy in the ward. You keep starting afresh when they go out and come back. So it took time to complete the tools’ (IDI, Ebonyi). ‘The mentees having to gather from different places where they live to enable them practice is challenging’ (IDI, Kogi). ‘Frequent and frequent strikes have seriously hindered our being able to translate knowledge to practice and bad roads for those living in hard-to-reach localities’ (IDI, Kogi). ‘Most of them are nurses and they do this shift thing and when you call them they will say it’s just only me that is on duty. To get them to practice is a great challenge and to get all the nurses to come together to practice is my greatest challenge’. Some patients will tell you that you should use olive oil. Most patients did not accept some of this new procedure like placing skin to skin but after explanations they accept. These women usually come to be delivered of their babies without these required items like the chlohexidine. It is the ignorance of the patient |
*denotes p value < 0.05 |
Excerpts from respondents are presented in italics with the interviewer prompts in plain print within the text, and as plain print. Each quote in the text is labeled by type of interview and State. In cases where quotes were taken from FGDs, when there was more than one response on the topic, these were presented together, with numbers separating the different responses.
Theme 1: Knowledge and skill learning outcomes of birth attendants
The participants reported improved knowledge and skills on hygienic practices such as hand-washing, use of partograph, neonatal care immediately after delivery, disease management and correct use of drugs.
A discussant in Ebonyi said:
‘Before we normally use glove as a protective device but now we wash before wearing the gloves (FGD, Ebonyi)
Also, on appropriate documentation a respondent in Kogi state, a discussant said:
I was not used to making use of partograph before this training. But now, we routinely use partograph to monitor the progress of labour (FGD, Kogi).
A respondent from Ebonyi on management of disease condition said that
‘We now do abdominal aortic compressions and it works perfectly for us. The simulators are good at helping me learn what I have not seen before like bimanual compression. With the simulators, I have learnt how this is done’ (IDI, Ebonyi State)
In both states, all the FDG participants opined that the simulation-based/m-Mentoring training approach enabled them gain improvement in skills/knowledge involving correct application of drugs such as use of magnesium sulphate in the management of pre-ecclampsia/ecclampsia, oxytocin to manage post-partum haemorrhage, use of misoprostol now used only when it is indicated rather than being used routinely for all clients during labour as was the case prior to the training. The use of magnesium sulphate was said to be the most valuable information or skill learnt during the training.
A respondent said,
‘Also the application of magnesium sulphat in preeclampsia and clamsia. Before I didn’t understand it but now even if am sleeping, and woken up, I can perfectly handle it. It has helped to realize that misprostol is not a must for every patient. Prior to the training, I could not use magnesium sulphate but now I can. I can now make use of magnesium sulphate in handling bleeding in women the way they taught us. The training equipped us on how to manage bleeding with Oxytocin’ (FGD, Ebonyi).
Theme 2: Trainees’ satisfaction with successful outcomes following the simulation-based LDHF/m-Mentoring approach
The respondents reported successful outcome on maternal survival, newborn/neonatal survival and patient trust/satisfaction such as feeling safer with health workers.
A reduction in maternal and neonatal morbidity and mortality were common theme across states and respondents. In Ebonyi states, a respondent said since after the simulation-based training commenced, they have not had any maternal or neonatal deaths in their facility. In Kogi state, a participant stated a reduced mortality from pre-ecclampsia and ecclampsia because of improved skills among the peer practice coordinators.
There is clearly noticeable improved new born care and reduced complications and mortalities among new born and their mothers’ (IDI, Kogi)
‘Firstly, since the training, we have not had maternal or neonatal deaths in our facility’ (IDI, Ebonyi)
Also
The training has made our clients to become confident in our ability and services as health workers, especially, after the application of respectful maternal care (IDI, Ebonyi
Theme 3: Facilitators of LDHF/m-Mentoring approach
Respondents identified facilitators of LDHF/m-Mentoring approach as support provided by the implementing partners through availability of equipment/supplies, use of telephone for communication, expert knowledge/skill and support from master mentors, incentives/welfare such as transport reimbursement and meals during training, support from management of facilities such as arrangement of duty rosters to enable trainees attend practices sessions and assessments through text messages and quizzes.
From Kogi:
- Through phone calls, I discussed topics on maternal and child health, real life experience, situation they have example PPH. I advise them to refer cases they cannot handle.
- The support I provided on phone depended on what they ask. Sometimes while taking delivery, they may ask questions through phone on areas where they needed assistance. They will tell me what they are doing while I seized that opportunity to correct them when I realized they were not doing it right. I had taught about manual removal of retained placenta, pre-ecclampsia and ecclampsia.
- There was once they took the picture of a baby during weighing and sent to me. I noticed the baby had cap on while weighing. I then took advantage of this to teach them how to properly take the weight measurement.
From Ebonyi:
Occasionally they call me when they have difficulty in the hospital, I also assist them. On phone, I discussed topics such as normal delivery, administration of magnesium sulphate and Manual removal of placenta.
‘Salaries have not been paid for several months. So I support them financially to enable still take care of pregnancy-related matters among pregnant women. Sometimes even paying their transport. At times we pay their transport, and they stay to practice. When I visit, usually I provide refreshment to enable me get their attention.
Excerpts from discussants on ways their facility management supported them in their role as a master mentor?
- ‘They release the auditorium key to those of us that stay at the quarter to practice even at night’.
- ‘They support by providing a training ground and allowing us to go for the practice’ (FGD, Birth attendants, Ebonyi).
Theme 4: Barriers to LDHF/m-Mentoring approach
The barriers mentioned include lack of funding/equipment/supplies and incessant strikes actions. The cost of obtaining or providing training and guidance from the master mentors was one of the most important barriers identified by different birth attendants across the two states. In both Ebonyi and Kogi states lack of finance for the various costs involved in the LDHR/m-Mentoring-related activities was mentioned more frequently and consistently than any other barrier, although comparing the two states, finance-related barrier was more mentioned by birth attendants in Kogi state. Unavailability of equipment hampered some birth attendants’ from translating what they have learnt into practice.
The use of the phone which requires recharge card purchases, the internet cost. Cost, initially, I was making frequent calls but later it was reduced to twice every month. I have not been paid for what I have spent so far in making calls to PPC (IDI, Ebonyi).
‘We don’t always have what we need to work with and all that we need to work with. The other area is equipment. There are not enough beds, delivery consumables are not enough, oxygen, scanning machine, insufficient wards and health workers, financial barriers and lack of instruments to work with’(IDI, Kogi).
On the question what was your experience facilitating peer practice, respondents said,
- ‘I find it difficult bringing everybody together at the same time because we run different shifts. It was very difficult to get members of the group to come together and practice due to our work schedule’ (IDI, Ebonyi).
- ‘There was the problem of so much distraction because the people were busy in the ward. You keep starting afresh when they go out and come back. So it took time to complete the tools’ (IDI, Ebonyi).