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Making it happen for global Women's Health

Improving care for more than 600,000 women.

Interview with Dr. Charles Ameh, deputy head of the Centre for Maternal and Newborn Health at the Liverpool School of Tropical Medicine.

“If we do not have the evidence then policies will not change.” - Dr. Charles Ameh

According to the World Health Organisation (WHO), 99% of maternal deaths occur in developing countries. The risk of a child dying before completing the first year of age was highest in the African region (60 per 1,000 live births), about five times higher than that in the Europe (11 per 1,000 live births).

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Six years ago the Liverpool School of Tropical Medicine began their innovative Making It Happen programme to increase the availability and quality of care for women and newborns in 11 countries in sub-Saharan Africa and South Asia. In 2015, the programme was recognised by The BMJ for their impactful work across the globe, and subsequently presented with The BMJ Women’s Health Team category award.

In partnership with the UK’s Department for International Development, WHO and local Ministries of Health, the programme has trained over 12,000 local healthcare workers,  ranging from undergraduate students to senior doctors. Skills and knowledge gained through practical training has helped to improve care for more than 600,000 women.

AfricaIn 2014, NHS volunteer faculty contributed in delivering over 100 short competency based courses in essential obstetrics/early newborn knowledge and emergency skills. These volunteers (mainly RCOG and RCM members) from a pool of 300 traveled to Bangladesh, Ghana, India, Nigeria, Kenya, Malawi, Pakistan, Sierra Leone, South Africa, Tanzania, and Zimbabwe for one to two weeks, often taking unpaid leave, in order to teach and mentor maternity care workers.

In addition to UK staff educating local nurses, midwives, and doctors, the programme has set up more than 200 fully equipped skills training rooms, implemented ‘train-the-trainer’ courses, and facilitated supportive supervision in the workplace. The programme trains staff across all parts of a hospital or clinic together, rather than teaching individuals from many different locations. This training approach results in greater skills retention after training,supports changes of practice and behavior.

The programme’s success can clearly be seen through objective evidence on both staff satisfaction and patient outcomes. Monitoring and supportive supervision takes place every three months to ensure the improvements achieved through training sessions are maintained, because “learning is a continuous process”, says Dr. Charles Ameh, deputy head of the Centre for Maternal and Newborn Health at the Liverpool School of Tropical Medicine.

Patient outcomes are the clearest evidence of the programme’s success. Statistics show a significant improvement in knowledge and skills, mean reduction in maternal deaths from obstetric complications of 15% and a 30% reduction in stillbirths. Positive changes were also seen on national levels. In Kenya, for example,  the proportion of supported health care facilities providing all Emergency Obstetric and Newborn Care signal function increased from 60% at base line to 100% after the training, up to 1 year after implementation.

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Equally important are the feelings of confidence, collaboration, and proficiency the training provided. The programme has proven helpful with everything from more rigorous record keeping and better communication between doctors and nurses, to earlier detection of complications and more accurate prescribing.

“A pregnant woman came in. After the first delivery we discovered there was another baby which we had not known about. We learned about how to detect and deliver the second twin during the training. Previously the doctor would come, but now we managed on our own.” – Nurse, Upazilla Health Complex

While some aspects of the programme differ between countries, overall its vision – to provide shorter, more practical courses that involve staff primarily concerned with maternity care and continues to monitor their progress afterwards – remains very effective worldwide. Other interventions implemented under the Making It Happen programme include, building capacity for audit and feedback for quality improvement, and to improve the recording and use of data for improved quality of maternal and newborn health care.

Future plans are to upscale training to regional and national levels and to shift from UK staff to local trainers. Ultimately Making It Happen aims to play an advisory role for governmental health policy while maintaining quality assurance. According to Dr. Ameh, “if we do not have the evidence then policies will not change.” With evidence as their ‘silver bullet’ the programme has been able to improve policies at a national level and ensure that the Making it Happen programme will continue to improve the lives of mothers and newborns.