Newborn Care Telementoring

Why is This Program Important?

The newborn period is recognized as a critical period for neonatal and child mortality alike. Globally, nearly 3 million babies die in the first month after birth. An estimated 98% of these deaths occur in low- and middle-income countries.

Who Can Benefit?

Through a funded grant project, AAP leveraged its expertise in newborn care and implemented a series of 12 sessions across three countries (Kenya, Pakistan, and Tanzania) over the course of a year. During the project period, AAP sought to improve newborn care practices through telementoring on newborn care practice gaps that were identified by in-country providers in select hospitals in three countries (Kenya, Pakistan, and Tanzania).  AAP technical experts partnered with pediatric societies and in-country newborn care providers to conduct a needs assessment of newborn care practice improvement, and to understand and evaluate current practices and clinical gaps. Identification of opportunities to strengthen care were made and a telementoring teaching network was developed to support the providers in learning best practices and new skills to increase the hospitals’ ability to address important newborn care needs. Technical support was provided to strengthen capacity for management of small and sick newborns.   

Program Details

Using the model of the grant-funded project for which all deliverables are now complete, the following program design and curriculum was utilized, and this is a model which could be replicated with other countries:

The telementoring curriculum was designed to meet the learning and care needs of the facilities in Kenya, Pakistan, and Tanzania, as well as to improve practices outlined in the UNICEF-AAP partner collaborative agreement. These included increasing the following metrics: 1) the number of babies that are immediately dried at birth, 2) the number of babies that are exclusively breastfed at discharge, and 3) the number of babies < 2500 g that receive Kangaroo Mother Care.

For all telementoring sessions, the AAP technical advisors worked closely with AAP staff to identify the essential topics to be included.  The in-country UNICEF contacts recruited participants in the facilities to participate in the sessions. Facilitated telementoring sessions for all three countries (Kenya, Tanzania, and Pakistan) concluded on July 15. A late-breaking topic of COVID-19 and newborn care was added for both East Africa and Pakistan, and these sessions were delivered separately and by different facilitators for the two regions.

How is the Program Implemented?

In each country, two facilities with high volumes of deliveries were selected by UNICEF field staff. Technical teams were established (one AAP expert with one UNICEF local contact per each of the three countries identified for this project) and supported by AAP staff and regional UNICEF staff. These teams conducted needs assessments and site visits to the hospitals identified. They analyzed the gaps and developed a workplan for improving skills and clinical practice around newborn care. Technical teams developed an ongoing content and monitoring and evaluation plan.

The clinical training gaps and needs included in the telementoring curricula were identified during the assessment visits and in consultation with the UNICEF regional/country-level staff. Telementoring sessions were held over a period of 12 months and totaled 12 sessions for Kenya and Tanzania sites together, and 12 for Pakistan sites separately. Expert facilitators, both U.S.-based and international, were identified by AAP staff based on their research interests and experience with the topic(s). Technical Advisors (one identified by AAP for each country) also facilitated topics.

Telementoring sessions were 60 minutes in length, with AAP technical experts and guest facilitators available after each session and beyond to ensure participants’ learning needs were adequately met. Each one-hour telementoring session had the following, agreed upon, structure:

• 5-10 minutes of case presentation by individual or a small group of participants (prepared in advance by participants, rotating among each facility.)
• 30 minutes of content presentation by the facilitator.
• 10 minutes of questions & answer and/or facilitated discussion.
• 5-10 minutes of discussion of the case presented at the beginning of the session.

Time for participant questions was built into the hour-long session format following the presentations yet encouraged by facilitators as questions occurred in real time.

To increase ongoing mentorship and allow for more direct engagement with participants, a WhatsApp group was offered.

Delivering Value and Impact

Overall, the telementoring project was well received and resulted in transfer of clinical knowledge, collegial discussion among facilitators and participants, and useful resources to aid clinical care practice. Although there were challenges, it is worthwhile to strengthen telementoring as an educational modality during times of COVID-19 but also for cross-sharing and facilitation of clinical expertise across different cultural, geographic, and resource contexts.

The needs assessment resulted in five major categories of topics presented in the telementoring sessions: 1) resuscitation, 2) Essential Newborn Care, 3) Small and Sick Baby, 4) follow-up care and prenatal counseling, and 5) COVID-19 and newborn care consideration. The AAP can offer expert facilitators to present on these topics and more and be available to serve in a telementoring relationship with clinicians to provide guidance.