G254(P) The impact of an obstetric birth and neonatal emergency life support education project on staff competences, organisational capacity and patient outcomes in a resource – poor setting

Abstract

Aims To design, deliver and evaluate the impact of a multi-structured educational programme on the management of obstetric and neonatal emergencies in a resource poor setting. Methods I assessed the impact of a unique multi structured educational programme on Obstetric Birth and Neonatal Emergency Life Support delivered to health care workers in North Eastern Uganda using the Kirkpartrick model. Quantitative assessment methods included analysis of results of a questionnaire assessment of participants’ pre and post course knowledge base and the number of early neonatal deaths pre and post course. T- test statistics was used to analyse the results. Qualitative assessment methods included structured and semi structured direct observation of skills and interviews with trained staff in the clinical settings 2 weeks and 6 months post course. Results 138 health care workers participated in the training course delivered over two days for qualified staff and one day for students. 85% of participants completed a before and after multiple choice questionnaire evaluating knowledge of obstetric birth emergencies. Across the whole group, there was a statistically significant increase in post course scores by 10% compared with pre course scores. 97.8% of the qualified staff that underwent a practical assessment of skills at new born resuscitation were considered competent. On site evaluation of skill and practice 2 weeks post course revealed that most students used their new skills competently in a resuscitation scenario but highlighted a ‘competency gap’ in some cases. Evaluation of staff progress at 6 months revealed significant organisational challenges that affected staff training and development. Analysis of neonatal deaths showed that there was a 30% reduction in number of deaths post course compared with a similar time epoch two years earlier. Conclusion This project demonstrated that UK style emergency life support courses on Obstetric Birth and Neonatal Life Emergencies can be delivered successfully in resource poor settings. The training led to newly acquired skill sets that in turn led to improvements in individual knowledge, organisational capabilities and neonatal mortality data. The challenge faced by organisers of educational programmes in similar settings is how to ensure that the new skills are embedded in order to sustain long term continuing improvements in clinical outcomes.