Page 100 - GHES-2-4

Global Health Economics and
Sustainability
Sustainable, competent health trainers

discussions of real-life clinical situations presented by the knowledge and skills (abdominal palpation, newborn
Palghar MTs. The essential skills included plotting and resuscitation, and eclampsia management) of the trainee
interpretation of partographs for monitoring the progress health providers from Palghar (Figure 1).
of labor, management of eclampsia, newborn resuscitation, The post-training assessment scores were significantly
and abdominal palpation of pregnant women. higher than those of the pre-training assessment scores
2.3. Data collection and analysis for clinical knowledge (p < 0.001), as well as for the three
skills, namely abdominal palpation (p < 0.001), newborn
To assess the process and outcomes of this six-step approach resuscitation (p < 0.001), and eclampsia management
used to generate a cadre of local MTs in Palghar, a mixed- (p < 0.001). This improvement in the post-training
methods research design was adopted. Quantitative data assessment scores of the trainee health providers was
from pre- and post-training assessments included scores evidence of the quality of the training delivered to them by
assigned for clinical knowledge and skills. These pre- and the Palghar MTs with support from the Pune CTs.
post-training assessment scores were analyzed using
Microsoft Excel 2016 and compared with the Wilcoxon 3.3. Personal and professional gains of the Palghar MTs
signed-rank test. The effect of the current training intervention on the
The qualitative data were collected through process Palghar MTs had three aspects: (i) increased clinical
documentation, structured observations, and in-depth competency; (ii) confidence as a trainer; and (iii) career
interviews with UK clinical experts (n = 3), Pune CTs growth – recognition and motivation.
(n = 5), and Palghar MTs (n = 12). These data were coded 3.3.1. Increased clinical competency and its
and analyzed thematically to identify key themes such as application
experience with the training pedagogy, effects of training
on building confidence and competencies, and application The Palghar MTs were practicing clinicians, staff nurses,
of training in clinical practice. and non-specialist or specialist medical doctors. They
reported internalizing the clinical protocols thoroughly
2.4. Ethics statement on account of repeated demonstrations of essential MNH
This training intervention research project received skills during the training. They acquired leadership skills
approval from the Institutional Research and Ethics and used the same for monitoring and mentoring their
Committee of the Foundation for Medical Research staff for appropriate case management and referrals.
(FMR/IREC/CH/01/2019). “When we demonstrated the skills in several
training batches, it got fixed in our heads. Now,
3. Results we have become more effective in managing any
The results of this training intervention research are crucial case.” (Palghar MT [senior specialist, Sub
presented as (i) the importance of the methodical six- District Hospital {SDH}])
step approach to developing Palghar MTs; (ii) evidence of “I check all the data for my PHC, especially all
increased competency of Palghar MTs with support from the high-risks cases and the referred-out data, to
Pune MTs; and (iii) personal and professional gains of the
Palghar MTs. 90 * 79.31 75.45 74.5 84.19
80
3.1. Importance of the methodical six-step approach 70 66.13
60
to developing Palghar MTs Mean score % 50 * *
*
A group of eight Pune CTs contributed to building a cadre 40 36.38 35.35 28.69
30
of 32 Palghar MTs (25 medical doctors and seven GNMs) 20
during the scale-up phase. Each of the six steps adopted 10
in the approach to building the cadre of Palghar MTs was 0 Clinical knowledge Abdominal Newborn Eclampsia
found to have its own advantages (Table 2). palpation resuscitation management
Subject of assessment
3.2. Evidence of increased competency of Palghar Mean score % pre-training Mean score % post-training
MTs with support from Pune MTs Figure 1. Pre and post-training assessment scores for clinical knowledge
In-person training received from the Palghar MTs and and skills of trainee health providers from Palghar (n = 463). Notes:
Although 505 health providers were trained during the training
Pune CTs with periodic virtual inputs from UK experts intervention, pre- and post-training scores for all the assessments were
resulted in considerable improvement in the clinical available only for 463 providers. *Indicates p < 0.001.

Volume 2 Issue 4 (2024) 5 https://doi.org/10.36922/ghes.2963