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In India, pilot programme builds skills to save mothers and newborns

© UNICEF/INDA2006-00059/Khemka
Sisters-in-law Anita and Sunita each have two daughters. More Indian mothers and children are surviving than ever, but there is more work to be done. To continue improving the survival rate, the State of Bihar has rolled out a UNICEF-supported programme that improves the skills of health workers.

According to a new report, India has realized impressive gains in child survival over the past two decades. However, at the current pace, the country is unlikely to achieve Millennium Development Goal 4, which aims to reduce under-5 mortality rate by two thirds between 1990 and 2015, unless related socio-economic, maternal and demographic, and environmental determinants are urgently addressed.

To view the full Infant and Child Mortality in India report, click here.

PATNA, India, 20 November 2012 - “Insert it slowly, from the nose, down to the stomach.  Be careful, or you may enter the lungs. Gudda is just a day old,” the doctor calls out.

As auxiliary nurse midwife Gita Bharti picks up the nasogastric tube and bends over the newborn, her hands shake.

“From the nose to the stomach, from the nose to the stomach,” she murmurs to herself as she starts measuring the correct tube length to be inserted into the newborn. “Eighteen inches,” she marks, and then starts inserting the tube slowly, carefully.

“It is going the wrong way. Take it out immediately,” interjects her watchful supervisor. “Try again, like this – slowly, carefully.” 

Little Gudda looks on, quietly, patiently, as Ms. Bharti and her five colleagues, all auxiliary nurse midwives, take turns inserting naso- and orogastric tubes through Gudda’s nose and mouth.

“I can do it,” gushes Ms. Bharti a few minutes later, beaming, hands steady – manoeuvring the tube skillfully.

“Luckily for us, Gudda is a plastic doll, a dummy, and we can practise again and again, till we get it right,” explains another auxiliary nurse midwife as the group moves on to the next skill station to learn and practise resuscitation on a mannequin.

Improving survival rates

India’s infant mortality rate decreased from 81 infant deaths per 1,000 live births in 1990 to 47 infant deaths per 1,000 births in 2011.  The maternal mortality rate also saw a decrease, from 600 maternal deaths per 100,000 live births in 1990 to 200 maternal deaths per 100,000 live births in 2010. Yet, there is much more to be done.

Over the past few years, the government of the State of Bihar, with support from UNICEF, has focused extensively on improving facility-based healthcare for newborns and mothers with newborn care corners, special newborn care units and labour rooms in first referral units across the state.

The results have been encouraging. More babies and mothers are surviving now.

Learning by doing

One initiative piloted by the state with UNICEF support is SkillsLab. SkillsLab is a specially designed laboratory in which participants like Ms. Bharti and her colleagues build knowledge and skills through hands-on practice using simulated scenarios and real equipment.

Over three days, in groups of four to five, participants are trained by a facilitator, who assesses their knowledge and updates or clarifies what they already know. The facilitator then demonstrates the correct procedure on a dummy child or mother and asks the participants to practise until they pick up the necessary skills.   

The SkillLabs are making a difference in both skills and confidence of the participants.

“On day one of the course, when I was assessed for using autoclave for sterilization, I could answer only half the questions. But now I know all answers and can also use it correctly,” says staff nurse Rukmini, who is undergoing the SkillsLab course at Benipur regional hospital in Darbhanga.

“They are now much more cautious of crucial steps, including the often-repeated but most neglected hand-washing and sterilization techniques to prevent infections,” says Medical Officer in Charge of Bahudurgarh Block PHC Dr. Mithilesh Jha, who has sent 45 nurses and doctors to the course.

Scaling up

Bihar is the first state in the country to have introduced the SkillsLab concept in the public health domain, especially in mother and child healthcare, says UNICEF Bihar Health Specialist Dr. Ravichandran Chandrasekaran.

According to Dr. Chandrasekaran, “At present, an average healthcare functionary is required to use several new gadgets and instruments to perform routine tasks related to antenatal, natal and postnatal care. Many rural [auxiliary nurse midwives] have never ever seen modern gadgets like digital blood pressure machines, radiant warmers, photoherapy units, let alone knowing how to use them correctly.”  

The state government is carrying out its plan to set up SkillsLabs in all 25 nurse training schools in the state to institutionalize this skill-building initiative aimed at saving mothers and children in Bihar.

“Having skilled-up around 1,130 health staff across the state in less than a year of starting up, the innovation is being considered for scaling-up at the state and national level by the Department of Health,” says UNICEF Chief of Field Office Dr. Yameen Mazumder.



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