Consultant - Conduct of Training of Frontline Health Workers From Secondary Health Facilities in Gombe State on Active Management of Third Stage of Labour and Obstetric Emergencies at Save The Children

The Organisation
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• No child dies from preventable causes before their 5th birthday
• All children learn from a quality basic education and that,
• Violence against children is no longer tolerated

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Background
Nigeria, Africa's most populous country with a population of over 180 million people, is ranked the second largest contributor to the global under–five and maternal mortality rates as well as the largest contributor in Africa. Every 10 minutes, one woman dies on account of pregnancy or childbirth in Nigeria, giving a total of 53,000 per year. This means about 800 women die in every 100,000 live births. In addition to these poor health indices, Nigeria’s newborn death rate (neonatal mortality) is put at 528 newborn deaths per day (one of the highest in the world). More than a quarter of the estimated one million children who die under the age of five years annually in Nigeria die during the first 28 days of life (neonatal period).

Haemorrhage and hypertension are the leading causes of maternal deaths, and for the new-born, complications during childbirth, preterm birth, and infections contribute to hundreds of thousands of lives being needlessly lost. Research shows that children in the poorest families have more than four times the risk of dying compared to counterparts in the richest families.

The majority of these deaths are caused by conditions that are preventable or treatable. In fact, nine of every ten new-born deaths are preventable. While some progress has been made to reduce these deaths over the past decade, the rate of change is not fast enough for Nigeria to meet the Sustainable Development Goals.

Key interventions and packages that could prevent 70% of new-born deaths in Nigeria exist, but coverage is low. For example, just half of all mothers are vaccinated against Tetanus Toxoid, only 43% of pregnant women deliver with the assistance of a skilled attendant and 32.8% of women breastfeed their new-born within the first hour of life; all of these with huge variations across the different regions in the country. Although policies are in place, action is needed at state and local levels to increase coverage and quality of life-saving interventions while closing the equity gap for the poorest families.

Active Management of Third Stage of Labour

• The third stage of labour refers to the period following the completed delivery of the new-born until the completed delivery of the placenta. Several complications encountered in the third stage of labour may lead to maternal morbidity. PPH may cause anaemia or lead to poor iron reserves, ultimately contributing to anaemia.
• Anaemia may cause weakness and fatigue. Hospitalization may be prolonged, and the establishment of breastfeeding may be affected.
• However, despite the known risk of the third stage of labour, relatively little thought or teaching seems to be devoted to the third stage of labour compared to the attention given to the first and second stages.
• To this end, this training is aiming to improve the skills of frontline health workers (Doctors/Nurses/Midwives) from secondary health facilities in Gombe state on Active management of 3rd stage of Labour and emergency obstetrics care in line with national guidelines.

Objectives:

• To build/strengthen the capacity of health workers in the diagnosis and management of obstetric emergencies including management of retained placenta, postpartum haemorrhage and shock
• To build/strengthen the capacity of 22 participants on the proper and effective use of uterotonic drugs during labour and delivery.
• To improve the clinical and interpersonal skills of trainees when providing the care

Methodology:

• An AMTSL objective-structured clinical assessment checklist will be used in the conduct of a Training Needs Assessment. All the secondary health facilities would be visited and the assessment checklist administered to assess the skills gap observed. The gaps observed would be used in the design of the training intervention. The TNA would be conducted in 3 zones in Gombe over a period of 5 days.
• The training will be led by a Lead Consultant along with 4 other resource persons (including Save the Children MNCH Advisor in Gombe State)
• The training would be a combination of both classroom and practical sessions. The practical session will consist of visit to a selected health facility in the state. All training materials (slides and manuals) would be drawn from FMOH approved guidelines for AMTSL.
• The delivery of the training will consist of adult learning techniques such as role plays, discussions, reading, audio visuals, and lecture presentations by participants, demonstrations, case study practices and clinical practice. The delivery of the training will also include use of mannequins for practical demonstrations.
• Pre-test and Post-test evaluations would be used in assessing knowledge gained by trainees.
• Post training evaluation will be conducted within 6 weeks of completion of the training by following up the trained health workers at their respective health facilities.

Participants:

• The training will be organized for 22 health workers who will be drawn from selected secondary health facilities in Gombe state.

Consultant Specification

• The consultant should be an experienced Obstetrician & Gynecologist (a fellow of West African Medical College/NPMCN) with a minimum of 5 years' post-fellowship experience.
• He/she should and an experienced trainer and should have undertaken a TOT in the delivery of AMTSL.
• He or she will work with 3 other facilitators (Doctors/Midwives who have a minimum of 5 years’ experience and also undertaken a TOT in the delivery of AMTSL training.

Expected Outputs:

• All trainees have been made to understand all the rudiments associated with active management of 3rd stage of labour and obstetrics emergencies.
• All trainees have developed skills and competence in the conduct of active management of labour and obstetrics emergencies.
• All trainees have developed good communication and interpersonal skills needed in patient care.
• A comprehensive report on the training of health workers on the active management of 3rd stage of labour and obstetric emergencies.