|Have an ongoing in-country presence in some way. Develop a multi-year plan. Work closely with in-country partners to select birth attendants to become trainers.|
|Community partnerships and providing printed materials in local language are important!|
|Hands on component, teaching each other, getting learners involved in questions, suggestions, sharing experiences—all are helpful and necessary!|
|Make time for lots of practice and sharing clinical experiences|
|Ensuring that we worked with hospital leadership well in advanced and throughout the training so that they were able to allow staff to have time off from clinical work to attend the training, assisted with ensuring the equipment was maintained, and encouraged participants to regularly practice skills after the training. It was also helpful, at times, to have non-clinical participants who had leadership roles in the health care center/hospital to understand what the course was about and how important it is.|
|1) Collaboration with NICHD, who had researchers participate with us. There were two US teams, one for India and one for Kenya. 2) Interprofessional collaboration with both faculty (Nurses and Physicians) and learners (Midwifes, Nurses and Physicians). 3) We trained 2 separate groups in India during the week. For the second training, the Indian faculty were learners at the first training. There was a travel day between the two courses in Belgaum and Nagpur, India). 4) Both Indian faculty and the US faculty were great collaborators and we integrated faculty within each table of six. 5) We asked the learners at both courses: a. What will you remember about HBB?, b. What will you no longer do (when caring for babies after birth)?, c. What practices will you incorporate into your care at birth? 7) An article was published with all India, Kenya, US faculty and NICHD, entitled, Helping Babies Breathe (HBB) training: What happens to knowledge and skills over time? (Bang et al, BMC Pregnancy and Childbirth (2016) 16:364 DOI 10.1186/s 12884-016-1141-3)|
|(1)Holding a separate Master Trainer day for those with the desire and initiative to be an MT. These were held on Wednesday, then the new trainers held mentored training on Thursday and Friday. (2) Returning to the site and holding more mentored trainings with the above new MT's and adding MT's as needed for the communities.|
|Practicing going through the entire book with the group and having a lot of hands on practice with bag mask ventilation|
|Work in small groups with a trainer; have adequate equipment for each learner; have enough provider guides for everyone in the native language; and have good interpreters |
|In our Uganda project we implemented HBB in 2012. We have volunteers at the facility frequently and we were able to "normalize" newborn resuscitation. We have extraordinarily low rates of newborn death, and both HBB and ECEB are a huge part of that. It took years to make it part of regular practice, but I believe it works because we had the ability to stay with it, normalizing it, modeling it. |
|Partner with local champions: Ministries of Health, NGOs, etc. And focus on Quality Improvement planning and implementation planning during initial training.|
|Observe the low trainer-to-learner ratio and use a "parking lot" to list questions and exceptions for discussion during the training.|
|Everyone should have a clearly understood role, and make sure to fully prepare the site of the training before attendees arrive.|
|Frequent, repeated practice is important|
|Provide regular follow up after the initial training to ensure skills are regularly assessed/reviewed and practice is ongoing. |
|Have 2 instructors (1 experienced mentor, 1 newer teacher); have local contacts to assist with managing materials/equipment; provide interpretation skills if needed; have a quiet space for training; and be sure to provide participants with lunch and snacks.|
1. Get local leadership support (hospital, community, health ministry)
2. Involve local providers
3. Engage experienced leaders
4. Build a team that is willing and able to adapt
5. Follow up after initial training
|It is critical to have community support and to also have an organization that can support continued training and review on the ground in your area. The biggest challenge isn't getting qualified teachers but having an ongoing administrative process for ongoing training.|
The skills of basic bag and mask ventilation are best taught in classroom but must translate into real practice. Many variables can be managed, taught, and mentored; however, one of the biggest barriers is fear. So successfully building confidence is important. The biggest challenge is the lack of knowledge that the air is the single biggest interventions to save a baby. Many providers think old habits, and focus on secretions (and suctioning).
We developed a core of eight "HBB Champions". They wear special colored scrubs and are known as the HBB teachers in their facility. We also have a higher ratio of bag and masks than penguins (deliberately). There is a bag and mask beside every bed, and in a given day we may do 7-10 resuscitations. Some are simple stimulation, while others require bag & mask. We ALWAYS start resuscitations at the mother's bedside – in order to delay cord clamping.
We also keep a NeoNatalie in the labor ward. This is vital to capture medical students, student nurses, student midwives, senior OBGYN etc for impromptu teaching.
We also provide weekly refresher trainings by core midwives and give them ongoing encouragement. They are also provided with booklets that get stamped for their professional development. This makes them proud to attend the lessons.
|Language can be a challenge some locations may require a bi/tri-lingual course. Ensure that the participants who need translation/interpretation are at the same table, along with a trainer who can translate. And be willing to change tables if it became apparent that a participant is struggling during the course. This requires that trainers really focus on teaching at the tables with the flip charts.|
|Engaging and mentoring participants is key! For example, on my second trip we trained 6 Master Trainers on day one and two. Then, those trainers taught with us for 8 days, teaching 36 providers each day. At the end of the two weeks there, the Master Trainers truly understood the HBS program and were independent in teaching. They have gone on to continue teaching since then.|
|Ensure your own team is prepared in advance of the training session. Work with Ministry of Health in the target country. And make sure to provide enough teaching supplies, materials, and equipment. |
|The two most important parts: lots of hands-on practice and developing a hospital-based coach/champion!|