The East African Health Worker Training program was conceived to complement GE Foundation’s donation program in Kenya, Uganda and Rwanda. The program team realized that many of the donated equipment were not being put to optimal use mainly due to lack of user knowledge. The CPHD proposed to get onboard local doctors and health workers who have had experience in handling similar equipment to provide user training and mentorship for health workers at the district hospitals that the GE Foundation had identified for equipment donations. To make the experience more comprehensive, the training was complemented with clinical updates for rural health workers, as they get minimal training after qualification.
The program focused on some key areas which were found to be the most deficient in terms of uptake:
- Anesthesia and critical care
- Care of critically ill children
- Life-saving skills for women in labor
Over 4 years, from 2010 to 2014, the CPHD team has trained more than 1000 health workers in these four critical areas.
A. Focused Bedside Ultrasound Training
The main objectives of this program was to equip all health workers in obstetrics units, including those who had no background in imaging, with the minimum skill in ultrasonography. This would make up for the shortage in ultra-sonographers and to reverse the impact of delayed diagnosis on morbidity and mortality rates. By the end of the training, the users were able to:
- Identify the number of fetuses in the uterus
- Identify the presentation of the fetus
- Determine localization of the placenta
- Identify fetal cardiac activity and estimating the rate
In delivery of this course, CPHD collaborated with the University of Washington’s department of Radiology and Ernest Cook Ultrasound Research And Education Institute (Kampala, Uganda).
B. Anesthesia and Critical Care and Oxygen
The CPHD identified two areas in which hospitals were failing to provide optimum care involving anesthesia and oxygen—use of monitors and sparing use oxygen (mostly for surgery and critically ill patients). Further, nitrous oxide—which is expensive—is still used in operating theaters despite a change in practice in most parts of the world. So, the hospitals expenditure in medical gases remained same even after GE Foundation donated and installed oxygen generators.
To address these challenges, the CPHD implemented the following interventions:
- Training of health workers in the use of medical air during surgery and new pain management approaches in order to eliminate nitrous oxide. For most facilities, this intervention alone led to a 40% reduction in costs of medical air
- Working with anesthesiologists to support training of rural-based health workers in areas of Basic Life Support, Advanced Cardiac Life Support and general use monitors
GE Foundation also donated equipment for the expansion of the infrastructure for training and provision of health services at the hospital training sites for the pilot program.
C. Emergency Triage and Treatment of Sick Children (ETAT Plus)
Deaths in children often occur within the first 24 hours of admission. Many of these deaths can be prevented if critically ill children were identified soon after their arrival in the health facility, and treatment started immediately. The Emergency Triage and Assessment Treatment plus admission care (ETAT+) course is a World Health Organization (WHO) initiated course that provides health workers with the knowledge and skills to provide good, effective care for sick children and newborns in the first 24 hours of their admission to hospital.
The trainings equipped the local facilitators with key pediatric and adult emergency skills. The courses included ETAT+, Primary Trauma Care Course, Life Saving Skills in Obstetrics and a Generic Instructors’ Course to equip the facilitators with skills to teach others.
Along with the Kenya Paediatric Association and KEMRI/Wellcome Trust, the CPHD delivered this course in 10 hospitals in Western Kenya, including the GE supported hospitals. After the midterm evaluation, the team restructured the training program to incorporate a leadership and mentorship program. At each facility, CPHD has identified, trained and empowered training champions. Through this network of highly motivated health worker, desired behaviors get reinforced on a continuous basis.
Equipment clinics were established in the sites and training provided for the local facilitators on the basics of the equipment and providing job aid on the same to be used for on the job training of other health workers.
D. Life Saving Skills for Women in Labor
The objective of this course was to ensure that health workers in targeted facilities were able to fully use the medical equipment donated for maternity units to improve care to women in labor. The training in Kenya included ETAT+, Primary Trauma Care Course, Life Saving Skills in Obstetrics and a Generic Instructors’ Course to equip the facilitators with skills to teach others. In Caesarian training, the training included management of obstetric cases and empowered the trainees in labor follow-up and critical decision-making for C-sections.
In Rwanda, British Basic Life support (BLS) standard training guidelines were used for training. Some of the core competencies in which provider skills were improved included: Early diagnosis and early response; acquired skills in the use of ambubag; acquired skills in decision making on when to use the defibrillator and when to do a CPR. There was also an observed decline in equipment breakdown.
The target health facilities established resuscitation teams to oversee implementation of resuscitation activities. These teams were led by the BLS training beneficiaries. Some of the health providers in Rwanda were trained in Advanced Cardiac Life Skills (ACLS) as general instructors.