Improving Quality of Maternal Care through Midwifery Refresher Courses A project experience in two districts of KP Prime Foundation Pakistan Dr. Aysha Masood Dr. Usman Ahmad Raza Dr. Saeed Anwar Dr. Farhat Rehana Malik Dr. Faisal Ali Shah

 Devastation caused by the floods of 2010 in Nowshera and Charsaada  1 million females affected  Shortage of skilled birth attendants (SBAs) and low antenatal coverage in Nowshera and Charsaada  Further rise in maternal mortality due to floods and inadequate maternal services  Project planned to contribute towards improvement of quality of care being provided by the midwives practicing in the community  Refresher training designed to fill gaps in knowledge and practices of SBAs  Devastation caused by the floods of 2010 in Nowshera and Charsaada  1 million females affected  Shortage of skilled birth attendants (SBAs) and low antenatal coverage in Nowshera and Charsaada  Further rise in maternal mortality due to floods and inadequate maternal services  Project planned to contribute towards improvement of quality of care being provided by the midwives practicing in the community  Refresher training designed to fill gaps in knowledge and practices of SBAs BACKGROUND

To contribute towards the improvement of maternal health through capacity building of midwives practising in the districts of Charsaada and Nowshera, by improving their midwifery skills and knowledge OBJECTIVE

PROJECT ACTIVITY TIMELINE Needs Assessment Conducted Coordination with District Health Officers Enrolment Criteria Established Location and Trainers for Training Selected Short listing of Received Applications Pre and Post Test Assessments of the trainees Analysis of Results

 Location: Ob-Gyn Dept of Kuwait Teaching Hospital, Peshawar equipped with OTs and labour rooms  Resource persons included experienced obstetricians, nurses  Trainees provided full boarding and lodging and stipend  AV aids and Mannequins used for interactive sessions  Rotations in ward including day and night shifts  Weekly feedback sessions on training quality from trainees  Weekly assessments of log books to tailor the practical component of curriculum according to needs of midwives  Pre/Post tests conducted to track effectiveness of training  Location: Ob-Gyn Dept of Kuwait Teaching Hospital, Peshawar equipped with OTs and labour rooms  Resource persons included experienced obstetricians, nurses  Trainees provided full boarding and lodging and stipend  AV aids and Mannequins used for interactive sessions  Rotations in ward including day and night shifts  Weekly feedback sessions on training quality from trainees  Weekly assessments of log books to tailor the practical component of curriculum according to needs of midwives  Pre/Post tests conducted to track effectiveness of training PROJECT DESIGN

CURRICULUM Practicum Health Education Review of Pelvic Anatomy & Physiology Puerperium & its complications Essential Care of New Born Antenatal Care Practical Basic Nursing Skills Recognition of signs of Birth Asphyxia + Practical Early Recognition of Danger Signs & Referral Partogram Practical Labour and its management Practical Eclampsia

RESULTS

 Marked increase in the knowledge and skills of the trainees  Results signify the need for improvement in midwifery skills  A focused, need based curriculum delivered in a hands-on manner can almost double the knowledge and skill levels of midwives  Trained midwives are practicing in the community and contributing to improved maternal care in their localities  Sustainability of the training hampered dependent on continued funding  Marked increase in the knowledge and skills of the trainees  Results signify the need for improvement in midwifery skills  A focused, need based curriculum delivered in a hands-on manner can almost double the knowledge and skill levels of midwives  Trained midwives are practicing in the community and contributing to improved maternal care in their localities  Sustainability of the training hampered dependent on continued funding CONCLUSION

 UNICEF. Pakistan Statistics. (Accessed 10 October 2013)  National Institute of Population Studies (NIPS) [Pakistan] and Macro International Pakistan Demographic and Health Survey : Key Findings. Calverton, Maryland, USA: NIPS and Macro International.  Trends in maternal mortality: 1990 to WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization  Fikhree FF. Reproductive Health In Pakistan: Evidence and future directions. JPMA  Provincial Bureau Of statistics- KPK.  Early Recovery Priorities for Flood 2010 in Khyber Pakhtunkhwa Provincial Disaster Management Authority Khyber Pakhtunkhwa.  Shadoul AF, Akhtar F, Bile KM. Maternal, neonatal and child health in Pakistan: towards the MDGs by moving from desire to reality. EMHJ  UNICEF. Pakistan Statistics. (Accessed 10 October 2013)  National Institute of Population Studies (NIPS) [Pakistan] and Macro International Pakistan Demographic and Health Survey : Key Findings. Calverton, Maryland, USA: NIPS and Macro International.  Trends in maternal mortality: 1990 to WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization  Fikhree FF. Reproductive Health In Pakistan: Evidence and future directions. JPMA  Provincial Bureau Of statistics- KPK.  Early Recovery Priorities for Flood 2010 in Khyber Pakhtunkhwa Provincial Disaster Management Authority Khyber Pakhtunkhwa.  Shadoul AF, Akhtar F, Bile KM. Maternal, neonatal and child health in Pakistan: towards the MDGs by moving from desire to reality. EMHJ REFERENCES