P0246 - An innovative program PRATIBIMB, (Program for Resuscitation and Active training for Better Infant and Mothers Outcomes after Birth) for training and empowering rural birth attendants in India

Background: In rural India (high NMR and MMR), nurse midwives with limited training provide sole mother-infant peripartum care. To improve the knowledge and skill of these birth attendants, we have developed a skilling program - PRATIBIMB, including modules from:
a. Helping Babies Breathe and Helping Babies Survive with ECEB and ECSB (AAP);
b. Helping Mothers Survive including Bleeding After Birth and Preeclampsia/Eclampsia (JPHEIGO);
c. Infection Control (Modified JPHEIGO) &
d. QI module (Modified POCQI developed with WHO, AAIMS, and USAID)

Aim: Evaluate the efficacy of PRATIBIMB in ‘Training of Trainers’ (ToTs) to improve the knowledge and skills of rural birth attendants.

Methods: Trained faculty from the US initially trained ToTs in a 5-day PRATIBIMB program. The ToTs were then supervised (1:1) for training others in their rural districts. Training success was documented by MCQ- tests and skill tests using specific OSCEs (Objective Structured Clinical Exams). Within two months of the training, all participants were administered a phone-based questionnaire, and their feedbacks were evaluated.

Results: Initially, 33 nurse midwives from AP, MP, and Telangana states - were trained in Hyderabad. Their pre to post-test knowledge score (67±18 to 85±18 (mean±sd); p <0.05) and their OSCE score (73% to 97%; p= 0.006) improved significantly.
In the first phase, 10 ToTs from Paderu (AP), returned to their district and helped train 35 new learners under (1:1) supervision. Learners showed a significant (p<0.001) increase in their pre to posttest scores (58±13 to 92±13) and passed their OSCEs for every module. In a second phase, 7 ToTs from Satna (MP) returned to their district and helped train 28 learners under supervision. Learners showed a significant (p<0.001) increase in their pre- to posttest scores (57±13 to 87±12) and all passed their OSCEs. The TOTs from Telangana have not yet done any further supervised training.
Feedback was received from 92 of the 96 participants, of whom 74% (59/92) had less than 1-year experience as birth attendants (range 0-31 years). Only 41% (38/92) were familiar with both maternal and Infant care.
PRATIBIMB training was highly valued by 93% (86/92) of trainees, and the most useful modules were voted to be: 1. HMS, 2. HBB, 3. HBS (in rank order). More than 85% of trainees were satisfied with the content, teaching method, and quality of training. Lack of training materials in their local language was the primary point of criticism from all three groups.

Conclusion: PRATIBIMB training program can be successfully used to certify ToTs who, in-turn can start training other providers. A public-private partnership with state governments to use PRATIBIMB for TOT and provider training may be an effective strategy for the rapid dissemination of knowledge and skills to decrease IMR and NMR in India.