Evaluation Of Midwife Training In Telangana (EMTT)

Duration of project
Phase 1 (Nov 2017- Apr 2018)
Phase 2 (May 2018- Mar 2019)
Phase 3 (Apr 2019- Sep 2019)
Phase 4 (Oct 2019- Mar 2021)

PHASE 1-3 (Nov 2017- Sep 2019):

Telangana has one of the highest caesarean sections in the country, more than 70% as
per the latest NFHS 4 report. Recognising this, the government of Telangana (GoT) has
introduced a cadre of midwives with the understanding that these midwives will be able to
provide quality Basic Emergency Obstetric Care (BEmOC) and thereby reduce the number of caesarean sections. GoT, UNICEF and Fernandez Hospital, Hyderabad have formed a consortium to provide an 18 months training course to 30 existing staff nurses. The Institute of Public Health (IPH) has been asked to evaluate this training program and an interrupted time series design was used.
The objectives of this evaluation program (Phase 1-3) during the training period are
1. To assess whether the trainees have acquired the relevant competencies.
2. To explain the reasons for the success (or lack of success) of this intervention
3. To assess the effects (positive and negative) of this training program on the health system
4. To make recommendations for strengthening the next round of the training program

PHASE 4 (Oct 2019- Mar 2021):

The training was for 18 months from November 2017 till May 2019. It was a hands-on residential training with a mix of theory and practical sessions mentored by midwife trainers. Now these Midwives (MWs) have been posted in various facilities in Telangana and are expected to establish midwife led maternity services. While the professional MWs have performed well in the training program, the test of their skills and competencies will be when they are posted in an independent practice situation to deliver respectful and quality maternal care. IPH has proposed to evaluate them in various facilities with the following study objectives
 To evaluate the competency and motivation of MWs in delivering respectful quality midwife led maternal care and compare them to the competency of SNs at specified intervals of the posting.
 To understand the reasons for a difference (in case there is a difference).
 To assess the enablers and detractors for midwife led maternity services and recommend interventions required to sustain such a program.

IPH has used mixed methods to capture information about the above objectives. We have used the following tools to capture the data regarding the training program during

PHASE 1-3 (Nov 2017- Sep 2019):

Structured Questionnaire. 

To the trainees

Before and after the training program

To assess the competencies of the participant

Patient satisfaction survey

To the patients

Before and after the training 

To assess the practices of the participant

Psychometric test 

To the trainees

Before and after the training program

Will assess the motivation of the trainees

Document review

Of the MCH Karimnagar hospital data

Of the participant performance

Of the logbooks and trainer notes 

Will help in understanding the reasons why the training is effective (or not effective)

In-depth interviews

With trainees, MCH staff and MO, trainers, policy makers and patients

Will help in understanding the reasons why the training is effective (or not effective)

Focus group discussions

With the trainees, MCH staff and trainers

Will help in understanding the reasons why the training is effective (or not effective)

Observation checklists

Of the participants performance

To document the attitude and practices of the participants

 

PHASE – 4 (Oct 2019- Mar 2021):

At the beginning of the posting period (October to December 2019)
A team of two persons will visit each facility for a period of 1 week (8 visits over 3 months) to
conduct the following

  • Structured questionnaire on practice or application of competencies to all the 30
    midwives as well as SNs in the facilities.
  • Structured questionnaire to score motivation of all the 30 midwives as well as SNs in
    the facilities.
  • Observation of the antenatal, triage, intra natal, newborn and post -natal care of at
    least 5 events in each category led by midwives.
  •  Exit interviews of women that have had antenatal checkup done by midwife.
  •  Semi structured Interviews with women who have been delivered by midwives.
  •  Collection of secondary data from the facility of posting.
  •  Chart audit – data extraction
  •  In Depth Interviews with 2 midwives from each center, 1 staff nurse and the medical
    officer
  •  In depth interviews with district health official
  •  Review of minutes of quarterly assessment of midwifery led maternity service by
    department of health, GoT

During the end of the posting period (May- July 2020)

  • Structured questionnaire on practice or application of competencies to all the 30
    midwives as well as SNs in the facilities.
  •  Structured questionnaire to score motivation of all the 30 midwives as well as SNs in
    the facilities.
  • Observation of the antenatal, triage, intra natal, newborn and post -natal care of at
    least 5 events in each category led by midwives.
  • Exit interviews of women that have had antenatal checkup done by midwife.
  • Semi structured Interviews with women who have been delivered by midwives.
  • Collection of secondary data from the facility of posting.
  • Chart audit – data extraction
  • In depth interviews with 2 midwives from each center, 1 staff nurse and the medical
    officer
  • In depth interviews with district health official
  • Review of minutes of quarterly assessment of midwifery led maternity service by
    department of health, GoT

PHASE 1-3 (Nov 2017- Sep 2019):

  • Baseline, Endline and Internship reports submitted to UNICEF. 

PHASE 4 (Oct 2019- Mar 2021):

The deliverables this research will result in are

  • Scientific evidence of the outcome of the training program – ability of the Midwives to apply
    and practice the learnings of the training in real life context.
  • A comparison between the knowledge and competencies of midwives and regular staff
    nurses. This will help UNICEF advocate for more such training programs.
  • One article in an international peer reviewed journal to highlight the effectiveness of the
    midwife training program on outcomes of maternal and newborn care and also its effects on
    the district health system.
  • Recommendations that will help fine tune the next round of training so that it can produce
    better results