Improving maternal, newborn, and child survival: A novel training package among frontline health workers in Southern Sudan

Background: Improving maternal, newborn, and child (MNC) health is a leading priority worldwide, and cost-effective solutions have been developed. However, MNC-related Millennium Development Goals remain those most at risk of not being achieved. A leading barrier is limited frontline healthcare capacity.

Purpose: To develop, implement, and evaluate a novel MNC survival package among frontline health workers in resource-limited settings. Southern Sudan, which suffers from some of the world's worst MNC health indices, was utilized as the setting.

Methods: In partnership with the Government of Southern Sudan, a multi-modal needs assessment was conducted through purposive sampling and involving key-informant interviews, focus group discussions, provider knowledge assessments, and facility surveys. Data were analyzed using traditional qualitative and quantitative techniques. These findings informed the development, implementation, and evaluation of the novel training approach.

Results: Our needs assessment involved 33 frontline health workers, 8 diverse health facilities in Eastern Equatoria, and stakeholders within 18 governmental and non-governmental organizations. Significant consensus emerged regarding the need for greater capacity among previously untrained frontline health workers. A MNC survival package was, therefore, developed that included action-based training, picture-based checklists, and reusable commodities. Program implementation began in December 2010 utilizing a training-of-trainers model. Monitoring and evaluation efforts are currently ongoing and consist of knowledge assessments, OSCEs, focus group discussions, and key process indicators.

Conclusions: A novel MNC survival package can be successfully implemented among previously untrained frontline health workers and help alleviate current human resource crises. Initial results are encouraging as further evaluation continues.