In June 2011, ACNM was awarded a multi-million dollar grant by a private foundation to scale up their pre-service education program in comprehensive family planning to 2 more midwifery schools after the successful pilot at the Kumasi Nurses and Midwifery Training College in Kumasi, Ghana from 2009-2011. The project focuses on strengthening 4 core areas: 1) program standards and regulation 2)curricula development and teaching methodologies 3) clinical and teaching skills of teachers (tutors) and preceptors 4) infrastructure, equipment and supplies. An exciting part of this project is the development of an electronic Learning Package in Comprehensive Family Planning being undertake in collaboration with the Center for International Medicine at University of California Los Angeles to be piloted at Kumasi Nurses and Midwifery Training College in 2012. The project addresses the core areas in three learning environments: 1) didactic learning in the classroom 2) skills practice area on models and 3) hands-on clinical practice with patients. It is expected that activities undertaken to strengthen these areas will also improve professional satisfaction and thus improve recruitment and retainment of both teachers and preceptors.
ACNM/CORE Group Healthy Moms, Healthy Babies Initiative
ZISSP is a USAID program led by Abt Associates that builds on the successes of the previous USAID funded Zambia Health Services and Systems Program (HSSP). ZISSP is designed to increase utilization of high-impact public health interventions in HIV/AIDS, malaria, family planning, maternal, newborn and child health and nutrition at district and community levels, through a health systems strengthening approach. ACNM is contracted to provide technical support and direction to the maternal health components of ZISSP's projects. Key areas include: supporting the national emergency obstetric and neonatal care (EmONC) training system; development of a post natal home visiting program; pre-service strengthening within the new direct entry midwifery programs; and strengthening community preparation and response to EmONC via Home Based Life Saving Skills (HBLSS).
The Averting Maternal Death and Disability (AMDD) program at Columbia University contracts with ACNM in the development of a community of practice (CoP) among non-physician clinicians in 6 African countries where their scope and training includes emergency obstetric care. ACNM is the acting secretariat for this CoP. As formative reseach for the CoP and in anticipation of scale up across the region, ACNM designed and implemented a survey regarding training, practice, and regulatory standards in each participating country. Although non-physician clinicians exist in many countries, this cadre of health care workers is just beginning to develop their professional identity. ACNM draws on its extensive experience developing core competencies, regulatory frameworks, and a professional identity for midwives to assist non-physician clinicians with this process.
The Namibian Government is committed to ensure quality maternal and child health. In their last DHS of 2006/2007, progress was found to be hampered by a number of challenges. There is a slight upward trend in infant mortality. The maternal mortality ratio also increased and major causes identified were related to emergency obstetric care services. However, increased numbers of births (81%) were found to occur in facilities by skilled birth attendants. In moving forward the government identified interventions to improve these services, in 2010 Namibia's Ministry of Health and Social Services and some of their donor partners (WHO, UNFPA, UNICEF and the CDC) requested ACNM provide assistance in designing and establishing a national Life Saving Skills program (LSS) training program. This program provides updates in emergency obstetric care knowledge, skills, and attitudes for health care providers such as midwives, doctors and nurses. As with other LSS programs, a systems approach has been used so critical elements including assessment, up-grading of training facilities, curriculum adaptation, preparation of trainers and target participants and monitoring and evaluation are addressed. ACNM's technical assistance to this program is ongoing.
PATHS2 is a project funded by the UK Department for International Development (DFID) and led by Abt Associates for whom ACNM is subcontracted to implement their signature Life Saving Skills program (LSS). PATHS2 is assisting the Nigerian government to improve the access of impoverished communities to quality health care particularly at the community level. One component of PATHS2's health system strengthening is in-service training for Community Health Extension Workers (CHEWs) in essential obstetric skills. ACNM is designing and implementing the Master's training and CHEW training program in essential obstetric care through ACNM's competency-based Life Saving Skills training program. ACNM is also working closely with PATHS2 to design and implement a supportive supervision system for the Master Trainers who will train all senior level CHEWs in 5 different states of Nigeria.
CORE Group is a network of more than 50 member organizations working in community health. One of its functions is to "develop and diffuse innovative cross-cutting community health program strategies, tools and best practices in order to overcome barriers to program coverage, quality, equity, and sustainability." This network includes many of the organizations who have implemented ACNM's pioneering community maternal and neonatal health program, Home Based Life Saving Skills (HBLSS)
. ACNM and CORE Group have partnered to leverage the experience of HBLSS implementing organizations to promote program learning, improve field implementation, and integrate HBLSS into existing programs. Other objectives include addressing the need for more Master Trainers, updating curriculum materials, and streamlining monitoring and evaluation. To date, a training of trainers for HBLSS was conducted with CORE Group members and the curriculum materials have been updated and finalized into a second edition. Future work will focus on creating a field-friendly implementation and facilitation guide.HBLSS Guatemala
In 2012, ACNM began partnering with Curamericas to implement Home-Based Life Saving Skills (HBLSS) in rural northwest Guatemala in order to reduce pregnancy- and birth-related mortality in the region that locals of San Sebastian Coatan call "The Triangle of Death." With a rate of 584 maternal deaths per 100,000 live births, these women face a 1-in-20 lifetime chance of dying in childbirth. At the root of this high mortality is a lack of timely access to adequate healthcare. Using ACNM's HBLSS curriculum, training was conducted to increase the knowledge and skills of local communities in the early recognition of maternal and neonatal problems and appropriate referral; the goal is to reduce maternal and newborn mortality in this area. Following the HBLSS Master Trainer Training, ACNM is working with Curamericas to develop a sustainable and effective training cascade and supportive supervision system for HBLSS in 12 communities.Scaling Up Family Planning Zambia
Beginning in 2012, ACNM was awarded a four-year grant to partner with Abt Associates on their Scaling Up Family Planning Program (SUFP) in Zambia project, funded by the Department for International Development of the UK. Zambia has one of the highest rates of maternal mortality in the world. The need for family planning and fertility are the highest in rural areas and among the poorest, least educated, and the youngest women. With this in mind, in collaboration with the local ministries of health and development, SUFP will launch their program in 26 districts of Zambia. ACNM will be working to build the capacity of the public sector to deliver quality family planning services through in-service programs for family planning providers, focusing on areas with the highest fertility rates and the most unmet need. Emphasis will be given to expanding availability of long-term reversible contraception methods and providing family planning services, with focus on adolescent girls and the poorest women. The program will also engage community health workers to sensitize men and others who influence family planning and will provide accurate information to address popular myths and misconceptions. To ensure sustainability of the project, outreach services as well as training and mentoring to public health workers will be carried out. Read more about SUFP from Abt Associates here
and from DFID here
.SHaRP: Strengthening Human Resources in Partnership, Zambia & Kenya
An award was made in November 2012 to the Averting Maternal Death and Disability (AMDD) Program at Columbia University
, to study the implementation of task shifting of cesarean sections (C‐sections) from physicians to associate clinicians (previously known as non‐physician clinicians) in Zambia and Kenya. The goal of the research is to develop guidance for low‐income countries seeking to implement and improve task shifting programs. The research aims to understand the process of moving from policy adoption of task shifting to actual implementation on the ground. Partners on the project include Chainama College of Health Sciences (Zambia), the American College of Nurse Midwives, Community Health Promotion Kenya (CHPK), and the Africa Network for Associate Clinicians (ANAC). Read more here
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