Title of the intervention: “Daaksh” National Skill lab Madhya Pradesh State: Madhya Pradesh Problem Statement: The millennium Development goal 4 & 5 on improving maternal and child health aims at reduction of MMR to 109/100,000 live birth and IMR to 41/1,000 live births in India by 2015. The state governments have taken various steps for accelerating the pace of decline in MMR and IMR. The need of time is to expedite this initiative with special focus on quality parameters. This requires capacity building of health care providers so as to make them proficient in technical skills and knowledge entailed for key intervention to ensure desired outcome. In spite of various types of training imparted to the service care providers, it is observed that the providers are less confident in applying skills. As well as there is limited and inadequate focus at district level to assess their competencies. Program Description: Comprehensive Skill Lab with skill stations is designed with the aim for up-grading and acquisition skills of health care providers to enhance their capacity to provide quality RMNCH services leading to the improved health outcomes. A Skill Lab comprises of skill stations where the trainees learn by practicing skills on mannequins, simulation exercises, demonstration videos and presentations. The certification of trainee is based on the competencies acquired during the training. The training at Skill Lab is provided by dedicated trainers who also provide on-site mentoring to ensure implementation of skills with adherence to technical protocols acquired by the trainees at Skill lab. The objective of Skill lab is to facilitate reinforcement of key standardized technical skills and knowledge to health care providers for RMNCH services thus ensuring availability of trained skilled personnel at health facilities Program Impact: In Madhya Pradesh, two Skill labs (Bhopal and Gwalior) are providing training to the health care providers posted at Delivery points since March 2014. By the end of April 2015 a total of 40 batches of staff trained involving 494 health care providers of districts of Sagar and Rewa division; where MMR is highest among the state. There are 168 delivery point in Sagar and 233 delivery point in Rewa Division. By the end of April 2015 the service providers of 45 facilities have been trained at skill lab. There are 39 skills that are imparted to the trainees, which include plotting and interpreting Partograph, managing normal delivery, preparation and method of using injection MgSo4 in prevention and management of eclampsia, active management of third stage of labor, initial management of PPH and shock by using Inj. Oxytocin, putting IV line and CAB approach, New born resuscitation and essential new born care.

At Skill Lab Bhopal other trainings facilitate was training for Master trainers of Bhopal and Gwalior skill lab along with trainers from UP, Bihar, Haryana and Gujarat. A total of 16 master trainers were trained. 4 batches of nursing tutors were also organized and trained 70 nursing tutors at Bhopal and Gwalior Skill Lab from 44 nursing institute. Till data 4 batches of Matrons, Nursing sister and Maternity Wing In-charge also have been conducted at Bhopal and Gwalior Skill lab and trained 54 trainers. After each batch the trainees have to provide feedback about the training content and their confidence level to practice the Skill acquired. 93.75% of the participants are of the opinion that during the training individual attention was given by the trainer and each trainee was given ample time for skill practice. 100% of the participants felt that the course content was sufficient and was helpful in upgrading Skill. 100% of the participants were confident in using the Skill acquired. 12 % of the participants were less confident about executing standard precautions in infection prevention and use of personal protective equipments. Apart from Class room teaching the skill lab trainers have to do mentoring visit to assess the skill enhancement and adoption of skills in routine practice. The mentors from Bhopal and Gwalior skill lab are visiting once in a week to the delivery point from where the trainees came to skill lab. Till date 10 mentoring visit have been carried out by trainers and provided hands on training after assessing the procedure. For further details contact: Faiz Ahmed Kidwai MD NHM ,Dr. Archana Mishra, Deputy Director Maternal Health, National Health Mission, Madhya Pradesh References Skill lab Operational Guidelines and Skill lab training manual Partner in implementing (if any): Established with technical and financial support of DFID- MPTAST Conclusions (for established) / Lessons learned (for introductory or emerging: Comprehensive Skill lab provides opportunity to practice on simulation or on mannequin which won’t be possible on actual client. During the mentoring visits by trainers of Skill lab, skills provided to SN and ANM are assessed and it was found that the trained staff is now confident and secure in executing and managing third stage of labor and eclampsia cases, consistently and correctly filling Partograph, maintaining 7 trays, undertaking new born resuscitation and decontamination sterilization of instruments and equipments. The mentors as and when needed provide hands on orientation to the labor room staff during their visit.

Scalability: In Madhya Pradesh with support of DFID- MPTAST, Skill labs are being establishes at divisional level in Indore and Rewa. The skill lab is providing mannequin and simulation based training which can be replicated for providing training of other skill sets based on requirement of other program like family planning, shock management, small surgical intervention etc. The skill lab can be used for skill assessment of newly recruited staff (ANM, SN, MOs) and their induction training. Proficiency certification can be provided to master trainers of different trainings at Skill lab. At Skill lab, facility staff can be oriented on clinical standardization of facility. Skill lab gives an opportunity for establishing virtual classroom.

National Health Mission Dept. of Public Health & Family Welfare, MP

DAKSHSkills Lab

MADHYA PRADESH

Situation Analysis Madhya Pradesh

•MMR 335 (2004-06)

221(2011-13)

•IMR 76 (2004-06)

54 (2013-14)

•TFR 3.5 (2005-06)

2.9 (2013-14)

Population: 725.9 lakhs

Live Births: 18.5 lakhs

Maternal Deaths: 4080

Neo.N Deaths: 68,845

Still birth: 9250

Disparity in MMR with high burden districts being Sagar (322), Shadol

(361) & Rewa (228)

Source SRS

Objectives of Skill Lab Focus on RMNCH+A Services

� Facilitates acquisition / reinforcement of key

standardized technical skills and knowledge by service

providers for RMNCH + A services

� Ensures the availability of skilled personnel at health

facilities

� Improves the quality of in service training

Objectives of Skill Lab Focus on RMNCH+A Services

� Provides Continuing Nursing Education / Continuing

Medical Education.

� Skill lab Training is a complementary to SBA Training.

Skill lab provides training on 39 skills in 6 days duration

DAKSH

Steps for Operationalization-

GoI guidelines

• Dy. Director Maternal Health (supportedby Skill Lab. Consultant)

State level- SNO:

• Divisional Joint Director (Supported byDivisional Programme Management Unit)

Divisional level-DNO:

•Nodal Officers in competency based training

models and operational guidelines on Skill lab.Orientation:

•Divisional Level Training Institute(SIHMC/RHWTC/DH)

Select a location:

With FA and TA of UKAID/MPTAST

Will start

shortly

Location and Coverage of skill Lab

Skill lab Catchment area Bhopal – Bhopal and Sagar Division , Gwalior - Gwalior and Jabalpur Division , Indore - Indore and Ujjain division , Rewa - Rewa Division

Gwalior

Rewa Div

Bhopal

Sagar Div.

Indore

N

E

W

N

E

W

Jamia Hamdard is the

National mentoring skills

lab

Operationalization of Skill Lab (as per GoI Norm)

Establishment� Approximate 3000 sq feet area is required to establish 4 Skill cabins

(12’ x 12’), 1 model LR (10’ x 12’) , 1 Seminar hall (1000 sq feet) & office (600 sq

feet)

� State Civil wing- construction/refurbishing of identified site for skills lab

� State Procurement cell- facilitate procurement of mannequin

� Regional Joint Director - Teaching/learning aids

� Human resource-1 MO+5 SNs as trainers ,1 DEO and 1 support staff (4 SNs on out

of 10 on Deputation),one faculty of training institute /DD of Div JD office

Operationalization� Preference given to SNs/ANMs of HPDs for providing skill lab training

� District wise list of Delivery points identified on the basis of delivery load.

� Scheduling of batches from high delivery load facility.

Mentoring� Regular one week mentoring visits every month by trainer from Skills Lab &

District level Skill lab trained staff.

� A roster has been prepared for all the teams

� Duration: Depends on delivery points to be covered and number of trained

personnel to be supervised.

Financials- per Skill Lab.

One time Cost Recurring Cost

1 Civil Work @ Rs. 20 lakhs HR 1 Medical Officer, 5 Staff Nurses, 1 DEO

and 1 Office Assistant

2 Procurement of mannequins @ Rs.

15 lakhs

Training Batches @ Rs. 1,32,400

3 Teaching aids @ Rs. 3 lakhs Mentoring visit @ Rs. 75,000 per month

4 Teaching and medical Equipment

@ Rs. 13 lakhs

Annual maintenance Rs. 50,000 per year

• Establishment cost of all 4 skill lab and operational cost for Bhopal and

Gwalior skill lab for the FY 2014-15 provided by DFID

• Provision of honorarium of Human Resource, Training, Mentoring Visit and

annual maintenance in PIP 2015-16

Time Utilization in Skill Labs (in days)Gwalior Bhopal

No. of days since intiation 208 338

Batches of Service providers 102 162

Mentoring visits 30 48

SBA trainers assessment 8 8

Nursing tutors training 12 12

LHV training 18 0

Matrons training 18 18

Master trainers of other states 0 12

TOT of Skill lab trainers 0 18

Total days utilised 188 278

% days 90.4 82.2

15.9

46.4

32.8

57.1

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Gwalior Bhopal

Coverage by Skills labFor Sagar & Rewa divisions –

Total Facilities: 233; 168 ; Training load: 732; 545

% of facilities covered % of staf trained

49

2014

5854

36

84.2

10

89.5

6256

8985

77

97.5

24.7

0

20

40

60

80

100

120

Standard MW

case sheet

used

BMW practices Partograph

maintained

AMTSL

followed

ENBC practised Skills of

Neonatal

Resuscitation

0 dose

immunisation

Adherance to

Infection

Prevention

practices

Improvement in quality of services in %

(From Feb 2014 to May 2015; n=115)

� The skill lab to be utilized for pre recruitment assessment and training to

Nursing College faculties and DPHNOs and Mos of delivery points

� 1596 identified MCH Centers and a total of 4264 Nursing Staff posted to be

trained through 4 skill lab in 2 years.

� Bhopal skill lab – Sagar and Bhopal Division (374 Facilities and 1393

Nursing Staff)

� Gwalior Skill lab – Gwalior and Jabalpur Division (538 facilities and 1559

Nursing Staff)

� Indore Skill lab – Indore and Ujjain Division (451 Facilities and 1428

Nursing staff)

� Rewa Skill lab – Rewa Division (233 facilities and 732 Nursing staff)

� Due to large catchment area with large number of delivery points and trained

staff mentoring visit would be a challenge.

� Online Capturing of improvement of quality of LR practices (MWMIS)

� Scaling up and improvement of training quality through Virtual Classes

Way Forward

Lets join hands….

…to save the mothers & newborns