Progress and challenges to introduce midwifery education in Nepal

Goyet, Sophie; Tamang, Laxmi; Alvarez, Valerie Broch; Shrestha, Ishwori Devi; Bajracharya, Kiran

doi:10.1016/s0140-6736(17)30341-0

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…The test showed that none of the loss in performance score was statistically significant b For skilled birth attendants only mentors further trained and mentored by provincial mentors, as successfully implemented in Uganda in the area of MNC [26]. Nepal has, however, taken a very promising step forward by launching a midwifery education program [27][28][29]. It is expected that the soon-to be deployed midwives will help improve the clinical skills of ANMs and nurses.…”

Section: Sustainabilitymentioning

confidence: 99%

On-site clinical mentoring as a maternal and new-born care quality improvement method: evidence from a nurse cohort study in Nepal

Goyet¹,

Rajbhandari²,

Alvarez

et al. 2020

BMC Nurs

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Background: We describe an on-site clinical mentoring program aimed at improving emergency obstetrical and newborn care (EmONC) in Nepal and assess its effectiveness on nurses' knowledge and skills. In Nepal, both the maternal mortality ratio (MMR, 239/100,000 live births) and the neonatal mortality rate (NMR, 21/1000 live births) were among the highest in the world in 2016, despite impressive progress over recent decades considering the challenging environment. Methods: From September 2016 to April 2018, three experienced nurses conducted repeated mentoring visits in 61 comprehensive or basic EmONC centers and birthing centers located in 4 provinces of Nepal. Using updated national training manuals and teaching aids, these clinical mentors assessed and taught 12 core EmONC clinical skills to their nurse-mentees. Clinical mentors worked with management mentors whose goal was to improve the nurses' working environment. We assessed whether the cohort of nurse-mentees performed better as a group and individually performed better at the end of the program than at baseline using relevant tests (chi-square test, Wilcoxon matched-pairs signed-rank test, and Kruskal-Wallis equality-of-population rank test). Results: In total, 308 nurses were assessed, including 96 (31.2%), 77 (25.0%) and 135 (43.8%) who participated in all three, two or only one mentoring session, respectively. In total, 225 (73.0%) worked as auxiliary nurse-midwives (ANMs), while 69 (22.4%) worked as nurses. One hundred and ninety five (63.3%) were trained as skilled birth attendants, of which 45 (23.1%) were nurses, 141 (72.3%) were auxiliaries and 9 (4.6%) had other positions. The proportion of ANMs and nurse-mentees who obtained a knowledge assessment score ≥ 85% increased from 57.8 to 86.1% (p < 0.001). Clinical assessment scores increased significantly for each participant, and therefore for the group. SBA-trained mentees had better knowledge of maternal and newborn care and were better able to perform the 12 core clinical skills throughout the program. Conclusions: Our study suggests that on-site clinical mentoring of nurses coupled with health facility management mentoring can improve nurses' clinical competences in and performance of maternity and newborn care. Assessing evidence of impact on patient safety would be the next stage in evaluating this promising intervention.

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Section: Sustainabilitymentioning

confidence: 99%

On-site clinical mentoring as a maternal and new-born care quality improvement method: evidence from a nurse cohort study in Nepal

Goyet¹,

Rajbhandari²,

Alvarez

et al. 2020

BMC Nurs

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“…Indeed, Nepal transcended lackluster performance globally to become one of the first countries to meet its maternal mortality targets in 2013, rapidly being celebrated as a redemptive success story [11]. The government has proven a consistent partner in this progress, having enacted a National Policy on Skilled Birth Attendants that has overseen the training of 7,000 SBAs since 2006 [12–16]. A more critical subnational analysis reveals persistent inequalities: Maternal deaths remain disproportionately high in the mountainous district, compared with the hills and lowland Terai, as well as among lower socioeconomic classes.…”

Section: Introductionmentioning

confidence: 99%

The quality of skilled birth attendants in Nepal: High aspirations and ground realities

et al. 2019

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Background While Nepal’s maternal mortality ratio (MMR) has improved overall, the proportion of maternal deaths occurring in health facilities and attended to by skilled birth attendants (SBAs), has nearly doubled over 12 years. Although there are numerous socioeconomic, environmental and other factors at play, one possible explanation for this discrepancy between utilization of skilled maternal care services and birth outcomes lies in the quality of care being provided by SBAs. The objective of this study is to determine how competent SBAs are after training, across multiple settings and facility types in Nepal. Methods We used a quantitative cross-sectional analysis to evaluate a sample of 511 SBAs, all female, from 276 sub-health posts (SHP), health posts (HP), primary healthcare centers (PHC), and district and regional hospitals in the mountain, hill, and terai districts of Nepal. Any SBA actively employed by one of these health facilities was included. SBAs who had received less than three months of training were excluded. Outcomes were measured using SBAs’ scores on a standardized knowledge assessment, clinical skills assessment, and monthly delivery volume, particularly as it compared with the WHO’s recommendation for minimum monthly volume to maintain competence. Results SBAs on average exhibit a deficiency of both knowledge and clinical skills, failing to meet even the 80-percent standard that is required to pass training (knowledge: 75%, standard deviation 12%; clinical skills: 48%, standard deviation 15%). Moreover, SBAs are conducting very few deliveries, with only 7 percent (38/511) meeting the minimal volume recommended to maintain competence by the WHO, and a substantial fraction (70/511, 14%) performing an average of no monthly deliveries at all. Conclusions Taken together, our findings suggest that while countries like Nepal have made important investments in SBA programs, these healthcare workers are failing to receive either effective training or sufficient practice to stay clinically competent and knowledgeable in the field. This could in part explain why institutional deliveries have generally failed to deliver better outcomes for pregnant women and their babies.

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“…By deploying midwives who are educated to ICM standards, especially low-income countries as highlighted in The Lancet series on midwifery [22][23][24] many maternal deaths and neonatal stillbirths can be avoided 25 . However, a specific midwifery curriculum is currently under review 26 . Hence general nurses, with less than one year of maternity training are the key maternity and mental health care providers in Nepal.…”

Section: Nursing Education and Training In Nepalmentioning

confidence: 99%

Mental Health Issues in Pregnancy and Childbirth: A Review of the Nepalese Nursing Curricula

Simkhada

Teijlingen

Ireland

et al. 2021

J. Manmohan Memorial Inst. Health. Sci.

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Background: Mental health is a difficult public health topic to talk about making it hard for frontline health workers especially countries like in Nepal. General Nurses are providing maternal and mental health care due to lack of midwives and specialist mental health nurses. Aim: This is the first study of this kind to review curricula on mental health components of pre-registration nursing training in Nepal. Methods: We conducted a rapid review of the nursing curricula on mental health and maternity care issues in Nepal. We reviewed 10 Nursing curricula of different levels of nursing. Content analysis tool was used to extract mental health related words or concepts to analyze the nursing curriculum. Findings: There is basic material included on both mental health and maternity care but nothing or little on the combination of the two topics. There appears to be a need for more communication skill, teaching and counseling at all levels of nursing. The nursing training need to focus on competency based and evidence based practice as successful strategies for perinatal mental health care. There is a great need for a curriculum to facilitate relevant training in Nepal.

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Progress and challenges to introduce midwifery education in Nepal

Cited by 4 publications

References 6 publications

On-site clinical mentoring as a maternal and new-born care quality improvement method: evidence from a nurse cohort study in Nepal

On-site clinical mentoring as a maternal and new-born care quality improvement method: evidence from a nurse cohort study in Nepal

The quality of skilled birth attendants in Nepal: High aspirations and ground realities

Mental Health Issues in Pregnancy and Childbirth: A Review of the Nepalese Nursing Curricula

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