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Train ALL
authorized
providers
Shared Highly
facilitation graphic
of practice materials
Change in
practice
Low-dose/
high- One day
frequency onsite
practice
Simulation-
based
Builds Essential
Clinical Decision-
Making Skills
12
Providers Trained (N=139)
Cadre N
Nurses and Nurse Midwives 74
Health Orderlies 22
India 82 88 90
Malawi 83 90 79
Self-Reported Confidence in Skills*
Before After p-Value
Training Training
Providing AMTSL 3.3 4.1 p<.001
Managing PPH 3.1 3.9 p<.001
Performing bimanual 2.9 4.0 p<.001
uterine compression
*Likert scale: 1 = “I cannot perform this skill”
5 = “I am extremely confident”
Learner Reaction*
Training Characteristic Likert Rating
(avg)
6:1 ratio is good 4.7
Time for training enough 4.0
Time for practice enough 4.3
Acceptability of English 3.1 - ANMs 4.1 5.0 - MDs
Facilitation Guide easy to understand 4.4
*Likert scale: 1 = “Strongly disagree”
5 = “Strongly agree”
Conclusions
• Good knowledge
transfer
• Highly acceptable
package
– Ratio, 1 day training,
simulator
• English acceptable in some contexts and with
some cadres, local language preferred in others
• Materials have been adjusted based on specific
feedback from the validation
Further Research
24