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Competency Based Trainings For Community Midwives

On Prevention of Postpartum Complications

(Genital Tract Fistula)

Report Prepared by;

Dr. Sarwan Kumar

Competency Based Trainings for Community Midwives Pakistan National Forum on Women’s Health (PNFWH)

Background:

Skilled attendance at the time of birth is considered to be the single most critical component for ensuring safe motherhood. The role of skilled birth attendants, in particular midwives and others with midwifery competencies, is widely acknowledged as being crucial to addressing maternal and newborn mortality and morbidity, and to promoting women’s and children’s health. More than 65 percent of women in Pakistan deliver their babies at home, mostly assisted by an untrained traditional birth attendant or Dais with increased risk of birth complications, especially in rural areas of Pakistan. Such poor care seeking behavior around childbirth can result life threatening complications arising from hemorrhage, unsafe abortion, eclampsia, sepsis and obstructed labour. Due to unavailability of Basic EmOC services and mishandling of obstructed labour by TBAs, about 5000 – 6000 new cases of Genital Tract Fistula occur each year in Pakistan. Majority of these cases can be prevented by training of step down service providers and development of linkage between community and health service providers. Through these intervention women will have access to quality Basic EmONC services through skilled health care providers during pregnancy and childbirth and develop a referral system for comprehensive EmONC to secondary and tertiary care. Community Midwives already working in the communities are not well sensitized regarding the management of obstructed labour and preventive measures of its consequences before referring to the comprehensive care services. Considering an important role of Community midwives in prevention and management of obstructed labour, PNFWH with


support of UNFPA and in collaboration with MNCH Sindh planned to organize five days competency based trainings on prevention of postpartum complications including genital tract fistula for MNCH deputed community midwives (CMWs) in Sindh. CBT Course Design: This refresher training course is designed to train CMWs on the provision of basic EmOC services at community level to avert maternal death and disability. The course builds on each participant’s past knowledge and takes advantage of her high motivation to accomplish the learning tasks in the minimum time. Training emphasizes doing, not just knowing, and uses competency-based evaluation of performance.

Training Objectives: Broad Objective: By the end of the 5 days training CMWs will be able to:

Describe basic EmOC and the team approach to the provision of care in relation to reducing maternal mortality and morbidity.

Describe the ethical issues related to EmOC, including feeling a sense of urgency, accountability for one’s actions, respect for human life, and recognition and respect for the right of women to life, health, privacy and dignity.

Use interpersonal communication techniques that facilitate the development of a caring and trusting relationship with the woman when providing EmOC.


Use recommended infection prevention practices for all aspects of EmOC.

Describe the process of rapid initial assessment and management of a woman who presents with a problem.

Identify the presenting symptoms and signs of shock and describe immediate and specific management.

Perform ABC approach of adult resuscitation before referral

Identify the presenting symptoms and signs; determine the probable diagnosis and use simplified management protocols for vaginal bleeding in early and later pregnancy.

Identify MVA Kit its specification and have detail knowledge of its processing.(But cannot provide service provision through MVA Kit).

Identify the presenting symptoms and signs, determine the probable diagnosis and use simplified management protocols for pregnancy-induced hypertension.

Identify and manage cord prolapsed.

Provide care during labor, childbirth and the postpartum period.

Get knowledge about breech delivery

Perform a vacuum extraction

Identify the presenting symptoms and signs, determine the probable diagnosis and use simplified management protocols for vaginal bleeding after childbirth.


Specific Objectives:

Demonstrate use of the partograph to monitor progress in labor, recognize unsatisfactory progress in a timely manner and respond appropriately.

Demonstrate clean and safe childbirth, including active management of the third stage of labor and examination of the placenta and birth canal after the birth.

Perform and repair an episiotomy

Identify and repair cervical tears

Can early recognize and management (competently catheterize) of obstructed labour before referral.

Training Methodology:

Presentations, illustrated lectures and group discussions

Case studies

Simulated practice with anatomic models (Demonstration & Hands on Practice)

Simulations for clinical decision-making Training materials: A number of training materials were used in five-days training, as follows:

Reference manuals

Audiovisuals on managing complications in pregnancy and childbirth

Presentation Graphics

Instruments and equipment

Anatomic models (Simulation Models) Participant Selection Criteria: Referred by MNCH Sindh


1st

Competency Based Training

2nd


3rd


4th


Date: 25th - 29th July 2011 Date: 12th – 16th Sept 2011 Date: 12th – 16th Sept 2011 Date: 15th – 19th Nov 2011

Venue: Red carpet Hotel, Sukkur Venue:Hotel Inter Park Inn, Sukkur

Venue: Sapna Inn , Larkana Venue: Al-Harmain Hotel, Karachi

Master Trainers:

Dr. Shamim Akhter

Dr. Shazia Khokhar

Dr. Hasan Ala

Master Trainers:

Dr. Shazia Khokhar

Dr. Reshma Kumari

Dr. Anjum

Dr. Sara Memon

Master Trainers:

Dr. Shahida Shaikh

Dr. Heeranoad

Dr. Bisma Zia

Dr. Yasmeen

Master Trainers:

Dr. Shabana Kanwal

Dr. Alia Tabassum

Dr. Kaneez Fatima

Dr. Ayesha Haq

Participants: 44 community midwives from district Khairpur & Sukkur

S.no Full name Place

1 Samina Rind Gari Khairo

2 Nazia Lashari Jacobabad

3 Noureen Naz Jacobabad

4 Saqiba Domki Kandh Kot

5 Khalida Brohi Kandh Kot

6 Jamila Soomro Jacobabad 7 Soomri Soomro Kandh Kot

8 Sabira Soomro Jacobabad

9 Zubeeda Wadh

Participants: 17 community midwives from district Khairpur & Sukkur S. no

Full name Place

1 Samreen Bashir Kashmore 2 Naseem Mirjat KotDiji 3 Farzana Shikarpur

4 Sanam Naz Thari Mirwah

5 Azra Thari Mirwah

6 Kalsoom Kumb 7 Benazir Kumb 8 Sobia Javed Rohri 9 Amina Sukkur 10 Shaheena Sukkur 11 Naseem Akhter Sukkur

Participants: 17 community midwives from district Larkana

S. no

Full name Place

1 Shabana Abro Gerello

2 Zulekhan Shah Pathan

3 Shahida Junejo Kachiunar

4 Akeela Noor Kumber

5 Nazia Somtio Larkana

6 SumeraMeerani Akil

7 ShahidaParveen Toof chacol

8 Samreen Naz Larkana

9 Khalida Surjani Sobdar

Participants: 49 community midwives from district Jamshoro, Dadu & Thatta

S. no

Full name Place

1 Sakina Chana Jamshoro

2 Sajida Memon Jamshoro

3 Kuhra Brohi Jamshoro

4 Sheena Brohi Jamshoro

5 SajidaKhatoon Jamshoro

6 Abida Parvin Jamshoro

7 Nazia Khaskho Jamshoro

8 Anjum Baloch Dadu


10 Naghma Chandio Wadh

11 Farzana Shaikh Gambat

12 Zabu-nisa Gambat

13 Salma Gambat

14 Shakeela Gambat

15 Amiran Gambat

16 Shabana Khairpur

17 Seemab Khairpur

18 Shahnaz Khairpur

19 Ghulam Fatima Khairpur

20 Shabana Afzal Khairpur

21 Fahmida Khairpur

22 Uzma Phulpoto Shikarpur

23 Farhana Shikarpur

24 Hurmat Mahar Shikarpur

25 Naseem Akhtar Shikarpur

26 Nasreen Asghar Shikarpur

27 Kiran Chana Sukkur

28 Irfana Qureshi Sukkur

29 Sumera Channa Pano Akil

30 Zubaida Khanum Ghotki

12 Shibzadi Kashmore 13 Tahira Zenab KotDiji 14 Heer Hisbari Sukkur

15 GhulamYaseen Khatoon Sukkur

16 Kalsoom Sukkur 17 Elizebath Rohri

10 Zarish Larkana

11 Ifat Shaheen Dokri

12 Koonj Larkana

13 Rubena Balleshah

14 Naseem Larkana

15 Fozia Solangi Larkana

16 Fozia Abro Larkana

17 Moona Baloch Larkana

9 Rukhsana Baloch

Dadu

10 Mehrunissa Baloch

Dadu

11 Khalida Dadu

12 Shabana Lashi Jamshoro

13 SaimaKhaskheli Jamshoro

14 Zaibunisa Jamshoro

15 Rukhsana Jamshoro

16 Hakeema 17 Mehwish 18 Nazia Jamshoro

19 Nasara

20 Kausar Shah Jamshoro

21 Saeeda Saho

22 Samina Ghari

23 Rabail Gul Dadu

24 Amber Atta Dadu

25 Sadaf Dadu

26 Saba Shereen Dadu

27 Hina Soomro

28 Rehana Dadu

29 Noorjahan Dadu


31 Zebul Nissa Ghotki

32 Asiya Sukkur

33 Hazooran Ghotki

34 Zainab Noor Ghotki

35 Aasia Pitafi Ghotki

36 Shabana Bano Khairpur

37 Ruqia Begum Khairpur

38 Sehrish Sukkur

39 Shabana Larir Sukkur

40 Rehana Marvi Rohri

41 Shumaila Rohri

42 Nusrat Thari Mirwah

30 Sanam Lakhiar

Dadu

31 Salma Dadu

32 Arbeli Pehwar Dadu

33 Gulshan Paree

Dadu

34 Moomal Dadu

35 Rabia Dadu

36 Shahnila Dadu

37 Afroze Dadu

38 Rabia Yousuf Dadu

39 TasleemuNissa

Dadu

40 KanwaloKandhro

Dadu

41 Shamila Dadu

42 Zahida Dadu

43 Hanifa Dadu

44 Bukhtermin Dadu

45 Safia Dadu

46 Soniya Dadu

47 Aneela Khaskheli

Thana Bla Khan

48 Sajida Parveen Jamshoro

49 ShaziaSoomro Jamshoro


Training Evaluation: Before starting the training session a written pretest with interview were conducted with individual participants in each workshop to understand the knowledge and concept of participants about basic maternal health care services, fistula and Basic EmONC. At the end of each presentation trainer ask question (Quiz) about the previous session in order to assess the understanding of the participants. Trainers also conducted periodic assessments through pre and post test in order to evaluate training. Recommendations and Conclusions:

All participants advised to go through the whole training material in detail and use it for your ready reference.




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Competency Based Trainings - pnfwh.org.pkpnfwh.org.pk/wp-content/uploads/2013/04/cbt workshop.pdf · probable diagnosis and use simplified management protocols ... Demonstrate use