Page 99 - GHES-2-4

Global Health Economics and
Sustainability
Sustainable, competent health trainers

(ii) Step 2: Training of potential master trainers with supported by one Pune CT. In addition to providing clinical
pre- and post-ToT assessment. guidance and feedback, this supportive supervision included
The 32 selected candidates participated in the ToT to teaching the new trainers the pedagogy for adhering to adult
become Palghar MTs, with pre- and post-ToT assessments of learning principles and ensuring adequate time for a reverse
clinical knowledge and skills as well as teaching skills. Adult demonstration of the relevant skill by each participant.
learning principles, including exhibiting a participatory, The MT demonstrated a clinical skill to a group of 5 – 6
interactive, and respectful learning approach, providing participants using a mannequin in a stepwise manner and
opportunities for participants to think and learn, and ensuring asked each participant to observe. Subsequently, each of
active engagement and hands-on practice for participants them was requested to demonstrate the skill to the MT,
with explanations of step-wise management, were applied engaging the rest of the participants in the process. The MT
during the ToT and all subsequent training. A simulation observed and provided feedback to each participant. This
of various high-risk cases with complications was used for step provided a longer time frame for the MTs to work as
discussing step-wise case management. The pre- and post- trainers with the mentorship of the Pune CTs.
ToT assessments included written examinations, structured
observations of teaching skills, and clinical demonstrations (v) Step 5: Regular quality assessment by the UK experts.
with mannequins using checklists. A total of 18 participants Due to travel constraints during the COVID-19
achieved a composite score of more than 85%, and the pandemic, structured quality assessment and feedback
remaining 14 scored in the range of 70 – 84% in the post-ToT sessions (n = 3) were conducted remotely by the UK
assessment out of the 32 Palghar MTs. experts. These sessions aided in ensuring the correct
demonstration of clinical skills and standardized
(iii) Step 3: Staggered induction of selected candidates as delivery of training content by the Palghar MTs. While
MTs. the Palghar MTs had the essential clinical knowledge,
A strategic process of staggered and structured they initially found it challenging to conduct case-based
induction was adopted for 32 Palghar MTs for conducting sessions, providing trainees with practice opportunities
training for health providers from the public health system and allowing time for reflection and learning. They
in Palghar. Master trainers with “intermediate” scores (70 were provided with feedback and tips during the initial
– 84%; n = 14) were paired up with those with the “highest” rounds of teaching demonstrations to help them adapt
scores (85% and above) (n = 18). After working with the to this more inclusive pedagogy. Most MTs implemented
highest-scoring trainers for at least two training batches, the corrective steps as suggested by the UK experts and
they were inducted as independent trainers. The Palghar
MTs then conducted training for 505 health providers over showed improvements in the subsequent rounds of skill
a period of 18 months (Table 1). demonstrations. Examples of improvements included
encouraging participants to consider the next steps in
(iv) Step 4: Continuous support and guidance to Palghar case management, exercising respectful communication
MTs by Pune CTs. throughout the case-based discussions, and accurately
Each training batch of Palghar health providers demonstrating skills such as abdominal palpation during
(n = 20 – 25) was conducted by a mix of highest- and pregnancy.
intermediate-scoring Palghar MTs (altogether 4 – 5)
(vi) Step 6: Virtual refresher training for MTs.
Although an intense single face-to-face training
Table 1. Cadre‑wise profile of health providers (n=505) intervention can lead to increased knowledge and clinical
trained by Palghar MTs skills, there is a risk of attrition over time. Moreover, face-
to-face training is both resource- and time-intensive.
Cadre No. of trained health providers
Repeating this was not feasible, especially during the
Auxiliary nurse midwife (ANM) 304 COVID-19 pandemic. Acknowledging this reality, a series
Community health officer (CHO) 73 of refresher sessions on essential MNH skills were organized
Medical officer 66 by the project team for the Palghar MTs with support from
General nurse midwife (GNM) 38 the Pune CTs. These sessions were conducted over a period
Lady health visitor (LHV) 18 of 10 months (starting 6 months after the ToT) using ECHO
Staff nurse 6 – Extended Community Health Outcomes India – a virtual
Total 505 knowledge-sharing platform for building capacity and
Note: LHV is an ANM who is trained for a period of 6 months to function sharing best practices through case-based learning using a
as a female health supervisor and provides supportive supervision and hub and spoke model (ECHO India, n.d.). These refresher
technical guidance to ANMs (Mavalankar and Vora, 2008). sessions were planned on the principle of learning through

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