Introduction

A. The Situation of Maternal and Newborn Care in the Philippines

The Philippines registered a Maternal Mortality Rate (MMR) of 172 per 100,000 in 1998 compared to 180 per 100,000 in 199 (!ational "emographic #ealth $%r&ey, 1998)' "espite the decrease in MMR, the red%ction of maternal deaths d%e to pregnancy related complication remains a challenge' The 1998 !"#$ indicated that postpart%m hemorrhage is the leading ca%se of deaths follo(ed )y hypertensi&e complications, sepsis, o)str%cted la)or and %nsafe a)ortion' *n the same s%r&ey, perinatal death (as placed at 18 per 1000 li&e)irths' +ompared (ith Malaysia and $ingapore (9'1 per 1000 li&e)irths , -'1 per 1000 li&e)irths, respecti&ely), the *nfant Mortality Rate (*MR) in the co%ntry is ./ per 1000 li&e)irths' *n the latest 200. !"#$, the percentage of 012 )a)ies (32 00 gms) is high at 1.4, not incl%ding those that (ere not (eighed' This is a reflection of the intra%terine gro(th retardation )ro%ght )y maternal depri&ation d%ring pregnancy' $till)irths or infant deaths, on the other hand, can )e a&oided especially in the critical first (ee5 of life if essential care is a&aila)le d%ring pregnancy, child)irth and the immediate postpart%m period' 6s e7plained in the Three "elays Model, maternal deaths occ%r d%e to delays in8 (1) deciding to see5 care for percei&ed o)stetrical complications9 (2) identifying and reaching the appropriate facility9 and (.) recei&ing appropriate and ade:%ate care in the facility' The 2orld #ealth ;rgani<ation (2002) pointed o%t that altho%gh most pregnancies and )irths are %ne&entf%l, appro7imately 1 4 of all pregnant (omen de&elop a potentially life= threatening complication that calls for s5illed care and some (ill re:%ire a ma>or o)stetrical inter&ention to s%r&i&e' *f ?mergency ;)stetric +are is a&aila)le, and (omen can access it in time, (omen@s li&es can )e sa&ed' The esta)lishment or %pgrading of strategic health facilities on 1asic ?mergency ;)stetric +are (1?m;+) aims to a&ert death and disa)ility among pregnant (omen and ne()orn )a)ies' 1?m;+ refers to the f%nctions that can )e pro&ided )y a team of e7perienced and trained s5illed )irth attendants composed of licensed doctor, n%rse and mid(ife (ho act as a team at the primary le&el in pro&iding )asic emergency care to mothers and )a)ies to a&ert maternal and ne()orn mor)idity and mortality' The 2#; recommends a ratio of one 1?m;+ facility per one h%ndred t(enty fi&e tho%sand (1812 ,000) pop%lation' The follo(ing are the si7 (/) )asic f%nctions of a 1?m;+ facility8 1' administer parenteral anti)iotics ( initial loading dose) 2' administer parenteral o7ytocic dr%gs (for acti&e management of the .rd stage of la)or only) .' administer parenteral anticon&%lsants for preeclampsia and eclampsia (initial loading dose) -' perform man%al remo&al of placenta ' perform remo&al of retained prod%cts /' perform assisted &aginal deli&ery

B. The Safe Motherhood Policy

The Philippines is committed to p%rs%ing the principles en%nciated in the +airo and 1ei>ing +onferences on Pop%lation and 2omen respecti&ely for the promotion of safe motherhood and (omen@s health, and to ens%re healthy ne()orns' #ence, the enactment of the "epartment of #ealth@s 6dministrati&e ;rder !o' 79s'2000, other(ise 5no(n as the $afe Motherhood Policy on 6%g%st 28, 2000' *t is restating its commitment to the aspiration of a healthy nation thro%gh a more &i)rant and &igoro%s $afe Motherhood *nitiati&es' The follo(ing principles form the )asis for programming the red%ction of maternal and perinatal mortality and mor)idity in the co%ntry8 Promotion of (omen@s rights and gender sensiti&ity9 6ccess to :%ality health and n%trition ser&ices9 Aoc%sing on health promotion, ed%cation and ad&ocacy9 ?sta)lishing lin5ages and de&eloping colla)oration to ens%re s%staina)ility9 Mo)ili<ing families and comm%nities to address family planning and maternal and ne()orn care9 ?mpo(ering comm%nities to recogni<e and correct gender discrimination and pre&ent &iolent and a)%si&e )eha&ior to(ards (omen and girls9 and Reporting and re&ie(ing all maternal deaths

Goal, Co era!e and Scope

The $afe Motherhood Policy em)races the goal of ens%ring safe motherhood and healthy ne()orns, hence, its main o)>ecti&e is to red%ce maternal and perinatal mor)idity and mortality' Bnder this policy, all (omen of reprod%cti&e age (1 =-9) and ne()orns %p to 28 days of life are target of inter&entions and ser&ices' $pecial attention shall )e gi&en to indigeno%s (omen, (omen among highly marginali<ed gro%ps (fisher fol5s, farmers, %r)an sl%ms, etc') and teenageCadolescent gro%ps' 6pproaches or strategies shall )e c%lt%re=)ased and gender=sensiti&e'

Guidelines and Procedures

1' ?ns%ring D%ality Maternal and !e()orn +are' Eood :%ality maternal and ne()orn health ser&ices8 6re accessi)le and a&aila)le as close as possi)le to (here the (omen li&e, and at the lo(est possi)le facility that can pro&ide the ser&ices safely and effecti&ely' 6re accepta)le to potential %sers and responsi&e to local c%lt%ral and social norms, s%ch as preferences for pri&acy, confidentiality and care )y female health (or5ers' #a&e on hand all essential s%pplies and e:%ipment' Pro&ide comprehensi&e care and lin5ages to other reprod%cti&e health ser&ices9 Pro&ide for contin%ity of care and follo(=%p9 6re staffed technically competent health care pro&iders (ho rely on clear g%idelinesC protocols for treatment9 6re staffed )y (or5ers (ho pro&ide respectf%l and non=>%dgmental care that is responsi&e to (omen@s needs9 *n&ol&e the client in decision=ma5ing, and see the client as partners in health care and

acti&e participants in protecting their o(n health9 and ;ffer economic and social s%pport to health care pro&iders that ena)le them to do the )est >o) they can9 ?nco%rage partner as (ell as family and comm%nity in&ol&ement in pre=natal and post= natal ser&ices'

2' ?lements of D%ality Maternal and !e()orn +are Prenatal Pregnant 2omen sho%ld ha&e at least fo%r (-) prenatal &isits for8 #ealth promotion8 ad&ice on n%trition (e'g iodi<ed salt %tili<ation) and health care, )reastfeeding, ne()orn care as (ell as co%nseling to alert (omen to danger signs and help plan for )irth9 6ssessment8 history ta5ing, physical e7amination and screening test li5e hemoglo)inC hematocrit determination, %rinalysis %sing the #ome 1ased Mother@s Record (#1MR), dental chec5=%p and prophyla7is' (!ote8 The #1MR has )een %pdated and replaced )y the Mother and +hild 1oo5) Pre&ention8 Tetan%s To7oid imm%ni<ation, Micron%trient s%pplementation (lo( dose Fitamin 6, M%ltiple micron%trient s%pplementation, ferro%s s%lfate) and early detection and management of complications' Treatment8 Management of se7%ally transmitted infections, anemia, to7emia, or other ris5 conditions' Natal" #eli ery Care 6ll deli&eries sho%ld )e attended )y a Gs5illed attendantH and is (ithin t(o ho%rs from first le&el referral or (ell=e:%ipped hospital that can handle emergency o)stetric cases and sho%ld ha&e the follo(ing ser&ices8 Pro&ide good :%ality care that is hygienic, safe and sympathetic on an on=going )asis9 Recogni<es and manage complications, incl%ding instit%ting life=sa&ing meas%res for mother and )a)y (hen called for9 Monitor progress of la)or %sing partograph9 Refer promptly and safely (hen higher=le&el care is needed9 and ?ns%re the s%pportCpresence of h%s)andCpartner' Postpartu$ and Newborn Care The postpart%m mother together (ith her ne()orn sho%ld ha&e at least 2 postpart%m &isits one month apart for the follo(ing ser&ices8 !e()orn screening for 8 congenital meta)olic disorder 6pgar scoring, proper cord care *dentification and management of pro)lems in mothers and ne()orn in the 1st 2ho%rs *mmediate and safe referral cases needing higher le&el care *nitiate e7cl%si&e )reastfeeding

+o%nseling and health promotion on e7cl%si&e )reastfeeding, follo(=%p imm%ni<ation, family planning, micron%trient s%pplementation, personal hygiene and care of ne()orn' 1+E imm%ni<ation and compete assessment of the ne()orn %sing Ero(th Monitoring +hart (EM+)

C. The Pre!nancy, Childbirth, Postpartu$ and Newborn Care %PCPNC& Manual ;ne of the strategies adopted to ena)le the ser&ice pro&iders )ecome competent in the management of (omen and their ne()orns (as the de&elopment of the Pregnancy, +hild)irth, Postpart%m and !e()orn +are8 6 E%ide for ?ssential Practice )y the 2orld #ealth ;rgani<ation' *t aims to g%ide health care professionals in the management of (omen and ne()orns in said periods as (ell as its application thro%gh an intensi&e s5ills training co%rse' The 2#;=P+P!+ Man%al (as adopted to the Philippine settings )ased on cons%ltations (ith technical gro%ps, academe, Philippine ;)stetrical and Eynecological $ociety (P;E$), Mid(i&es 6ssociation and on the res%lts of the pilot testing of the man%al in the fi&e areas of local go&ernment %nits (0EBs) in the co%ntry' This local &ersion ser&es as the main reference )oo5 for the $5ills Training in 1?m;+' This (ill g%ide ser&ice pro &iders in their clinical decision=ma5ing thro%gh a systematic collection, analysis, classification and %se of rele&ant information )y s%ggesting 5ey :%estions, essential o)ser&ations andCor e7aminations and recommendingCapplying appropriate e&idenced=)ased inter&entions'

About Guide

the

Trainer's

Bac(!round of the Trainer's Guide The WHO document -- Pregnancy, Chilbirth, Postpartum and Newborn Care: A uide !or "ssential Practice #PCPNC$(as adopted as a reference man%al for health care pro&iders responsi)le for the care of (omen d%ring pregnancy and child)irth, and their ne()orns' To facilitate the cond%ct of training, this training g%ide (as de&eloped in colla)oration (ith &ario%s partner organi<ations that ha&e a sta5e on red%cing maternal deaths in the Philippines' 6 m%lti=sectoral P+P!+ Tas5 Aorce (as created, composed of representati&es from the "r' Iose Aa)ella Memorial #ospital, Mid(i&es 6ssociations, 2#;, B!*+?A, I*+6 and B!AP6 (ith ";#!+"P+ as chair and con&enor' $e&eral meetings (ere cond%cted (ith s%pport from B!*+?A and 2#; to )rainstorm on ho( )est the training can impro&e the health pro&iders@ capa)ility on managing emergency complications of pregnancy and child)irth' 6 meeting hosted )y the 2#; (as cond%cted to generate more technical inp%ts and solicit endorsement of the E%ide from other partners li5e the Philippine Pediatric $ociety, Philippine ;)stetrics and Eynecology $ociety, and three gro%ps from the mid(i&es@ associations' The last three series of meetings to finali<e the Trainer@s E%ide and the pre=testing (as f%nded )y the B!AP6' 6 total of 2. health ser&ice pro&iders from lying=in or )irthing facilities, Pro&incial #ealth ;ffices from si7 B!AP6 assisted pro&inces, and from the +enter for #ealth "e&elopment participated and ga&e a comprehensi&e assessment of the training' 2ith s%pport from I*+6, a t(o=day cons%ltati&e (or5shop (as cond%cted )y ";# to pro&ide the different sta5eholders (ith the opport%nity to f%rther re&ie( the draft and recommend (ays to impro&e it' 6n additional off=shoot of this (or5shop (as an agreement to come %p (ith a ";# 6dministrati&e ;rder entitled G*mplementing E%idelines for 1asic ?mergency ;)stetric +areH that (ill g%ide decision ma5ers and implementers of 1?m;+ in the co%ntry' )ow to *se the Trainer's Guide This Trainer@s E%ide shall pro&ide facilitators and reso%rce persons the standard technical content and design of 1?m;+ training' *t promotes the team approach in the deli&ery of 1?m;+' The o&erall o)>ecti&e of the training is to enhance the s5ills of )irth attendants (doctors, n%rses, mid(i&es) in assessing and managing conditions related to pregnancy, child)irth, postpart%m and ne()orn care' *t is an 11=day training (ith -=day didactic sessions and 7=day clinical practice' The o)>ecti&es of the didactic phase are as follo(s8 apply the principles of good care9 enhance clinical >%dgment )y identifying and prioriti<ing patients thro%gh the

application of D%ic5 +hec5 and R6M9 disc%ss the impact of doing an immediate general assessment of the (oman %pon cons%ltation at the health facility9 perform an assessment and management of a (oman d%ring la)or, after deli&ery and discharge from the health facility9 recogni<e and respond to o)ser&ed signs or &ol%nteered pro)lems of mothers9 sho( ho( to care for the ne()orn9 demonstrate co%nseling s5ills on the essential ro%tine and emergency care of (omen and ne()orn d%ring pregnancy, child)irth, postpart%m and post=a)ortion9 identify comm%nity s%pport mechanisms for maternal and ne()orn health'

The didactic part co&ers nine (9) mod%les, namely8 (1) ;&er&ie( of 1?m;+ and the P+P!+ Man%al9 (2) Principles of Eood +are9 (.) D%ic5 +hec5 and Rapid 6ssessment and Management9 (-) 6ntenatal +are9 ( ) 0a)or, "eli&ery and *mmediate Postpart%m9 (/) PostPart%m +are9 (7) !e()orn +are9 (8) +o%nseling9 and (9) Mo)ili<ation of +omm%nity $%pport' The practic%m phase co&ers t(o (2) practic%m acti&ities for clinical s5ills on 1?m;+' *t aims to enhance the competencies of ser&ice pro&iders in applying )asic emergency o)stetric care to all (omen and their )a)ies' *ts sessions incl%de8 (1) ;rientation for the Practic%m9 and (2) Practic%m 6cti&ities for +linical $5ills in 1?m;+' The practic%m session shall ta5e place in an accredited training hospital8 at the o%tpatient department, emergency room, maternity (ard, la)or and deli&ery room and (here&er trainees can practice their s5ills' !ear)y lying=in clinics and )irthing homes, health centers and r%ral health %nits may also ser&e as practic%m sites pro&ided they are accredited as training %nits' The training team shall )e composed of8 (1) a training director9 (2) at least fi&e core trainers9 and (.) a financeCadministrati&e officer' To ens%re a common %nderstanding on the Trainer@s E%ide and P+P!+ Man%al, a t(o=day facilitator@s meeting )efore the training proper (ill )e cond%cted for the team and other in&ited reso%rce persons' The reso%rce persons or facilitators for the training (ill )e selected )ased on their e7perienceCe7pertise in the area of maternal and ne()orn care, orientation on P+P!+, e7pos%re to cond%ct of training acti&ities and (illingness to )e part of the team' The Trainer's Guide is or!ani+ed in three parts, Part - pro&ides chec5list on pre=training preparation' *t consists of the technical and administrati&e re:%irements (hich need to )e prepared to ens%re smooth implementation of the training, s%ch as8 (1) organi<ation of the training team9 (2) selection of reso%rce9 (.) persons and training=of=trainers9 (-) identification of partner instit%tions and facilities9 ( )selection of participants and training needs assessment9 (/) setting of sched%le9 (7) de&elopment of co%rse sched%le and preparation of training materials9 (8) cond%ct of facilitators@ meeting9 and (9) f%lfillment of administrati&e re:%irements' Part . presents the nine mod%les of the didactic phase and t(o mod%les of the practic%m phase' ?ach mod%le and session incl%des presentation of the o)>ecti&es, topics, d%ration, methodology and materials needed' This part also pro&ides practical tips on ho( to monitor and e&al%ate )efore, d%ring and after the co%rse, incl%ding the preparation of an action plan'

Part / pro&ides an o&er&ie( of post=training acti&ities (hich the trainers and participants can %nderta5e colla)orati&ely' This part incl%des disc%ssion of o%tcome indicators for the training, the need for contin%ing comm%nication, ho( to monitor and e&al%ate training o%tcomes and the importance of doc%menting e7periences' The introd%ctory part (al5s the trainer or reader into the conte7t of the g%ide (hich incl%des the sit%ation of maternal and ne()orn care in the Philippines, the $afe Motherhood Policy and the conte7t of the P+P!+ (hich ser&es as the main reference )oo5 of the Trainer@s E%ide' To facilitate the %se of this )oo5, especially finding information, the three ma>or parts and the 6nne7 (hich incl%des the Trainer@s !otes are color coded8 Part 1 Pre=Training 6cti&ities Jello( Part 2 +ond%ct of the Training +o%rse 6' "idactic Phase 1l%e 1' Practic%m Phase Pin5 +' Monitoring, ?&al%ation and ;range 6ction Plan Part . Post=Training 6cti&ities Ereen 6nne7 Fiolet 6 Glossary is also incl%ded in page 87 to aid the trainers and readers in %nderstanding the meanings of (ordsCterms %sed in the g%ide' The Anne0 Portion incl%des the trainer@s notes, g%ide to the po(erpoint presentation, and sample training sched%le for the didactic phase' The trainer@s notes contain the &ario%s reference and presentation materials' $ample forms and tools are also incl%ded in this section' Together (ith this Trainer@s E%ide are the instr%ctional materials s%ch as the +ompact "is5 of Po(erPoint Presentations, a set of transparencies of selected presentation materials and the P+P!+ Man%al as main reso%rce )oo5'

PreTrainin! Preparation
Prior to cond%cting the s5ills training on 1?m;+, certain preparations need to )e done to ens%re its smooth implementation'

Technical Preparation
1r!ani+ation of the Trainin! Tea$ 6 Training Team needs to )e organi<ed to lead the follo(ing responsi)ilities8 Management of the training (hich incl%des planning, organi<ing and r%nning the training sessions in an effecti&e and colla)orati&e manner9 Mentoring )y pro&iding g%idance and s%pport to indi&id%al participants9 Planning ho( the ne(ly gained competencies can )e applied )y the participants in their (or5 place9 Moti&ating participants )y s%pporting them in meeting their learning o)>ecti&es9 and +ond%cting Training of +ore Trainers (T;+T) among reso%rce personsCfacilitators for the different sessions in the didactic phase and area facilitators for the practic%m phase' The composition of the team incl%des8 Training "irector +ore Trainers 6dministrati&e and Ainance ;fficer Technical Preparation Selection of 2esource Persons and Trainin! of Core Trainers %T1CT& The selection of reso%rce personsCfacilitators sho%ld ta5e into consideration appropriate matching of their :%alifications (ith the training o)>ecti&es and methodology, as (ell as the characteristics of the participants' The recr%itment process sho%ld )e g%ided )y selection criteria' The T;+T aims to le&el=off %nderstanding among the Training Team, reso%rce personsCfacilitators for the didactic phase and area facilitators for the practic%m phase a)o%t the goals, o)>ecti&es and mechanics of the 1?m;+ s5ills training' The disc%ssionsCmeetings (ill foc%s on the follo(ing8 +onte7t of *MP6+ on $afe Motherhood +onte7t of the P+P!+ as a Reference E%ide Mod%les for the 1?m;+ $5ills Training ;rientation on the Trainer@s E%ide, partic%larly8 #idactic Phase= session o)>ecti&es, gro%p acti&ities, e7pected o%tp%ts and materialsC reso%rces needed' Practicu$ Phase o)>ecti&es hospital departmentsCareas that (ill )e in&ol&ed hospital personnelCstaffCarea facilitators (ho (ill )e in&ol&ed re:%irements of the practic%m and the e7pected technical assistance from the area facilitators determine sched%le of rotation to appro7imate completion of re:%irements (may %se as

)asis res%lts of Training !eeds 6ssessment (T!6) to address the gapsCs5ills re:%ired )y the participants on 1?m;+) formsCchec5lists to )e filled=%p )y the participants formsCmonitoring tools to )e accomplished )y the area facilitators to aid in facilitating application of s5ills cond%ct of mid=practic%m assessment ho( to effecti&ely pro&ide technical assistance and monitoring of the participants incl%ding proper feed)ac5ing of o)ser&ations proper cond%ct and decor%m d%ring practic%m

Monitoring and ?&al%ation of the Training (d%ring and after) +riteria for the $election of Reso%rce Persons8 ?7perienceCe7pertise in the area of maternal and ne()orn care ;rientation on P+P!+ ?7pos%re to cond%ct of training acti&ities 2illingness to )e part of the team Identification of Partner Institutions and 3acilities *nstit%tions and facilities that (ill )e in&ol&ed in the deli&ery of the training co%rse sho%ld )e identified early on' The identification process sho%ld consider the follo(ing criteria8 Training *nstit%tion for Practic%m 6ccredited )y Philippine ;)stetrical and Eynecological $ociety (P;E$) or "epartment of #ealth for teachingCtraining +an )e go&ernment (as co&ered )y ";# 6dministrati&e ;rder) or pri&ate instit%tions that (ill meet the criteria (co&ered )y M;6 (ith 0ocal Eo&ernment Bnit) #ealth Aacilities for Practic%m 2ith 1%siness Plan (according to Phil#ealth 6ccreditation scheme) 6ccessi)ility of the facility +apa)ility of the personnel to model correct ser&ice pro&ision and assist participants d%ring practice 2ith ade:%ate caseload for clinical proced%re (1?m;+) 6&aila)ility of essential s%pplies and e:%ipment

Training Fen%e for the "idactic 6de:%ate space for the n%m)er of participants and acti&ities that (ill )e cond%cted, incl%ding )rea5=o%t gro%ps 6&aila)ility of e:%ipment and s%pplies 6&aila)ility of facilities for comm%nication +omforta)leC(ell=appointed accommodation *n identifying partner instit%tion and facilities, )ear in mind that Gthe training scenario sho%ld )e as close as possi)le to the (or5 en&ironment of the participantsH (2#;, 19978-0)' *n this (ay, there is greater chance of p%tting into practice the ne( s5ills learned in their o(n (or5 sites (Mclnerney et al', 20019 I#P*?E;, 2001)' Selection of Participants and Trainin! Needs Assess$ent

The s%ccess of the 1?m;+ s5ills training co%rse (ill also depend on a caref%l selection of participants' +riteria for selecting participants may incl%de8 0EB Participant 0EBsCpro&inces (ith high Maternal Mortality Rate (MMR), neonatal death and lo( +ontracepti&e Pre&alence Rate (+PR) 6&aila)le 1?m;+ facilities of 0EB 6de:%ate s%pport of 0EB in terms of %pgrading facilities, a&aila)ility of s%pplies and allocation of )%dget 0EB (ith *n&estment Plan and reso%rce management capa)ility 6&aila)le h%man reso%rces for team composition Pri&ate instit%tions (illing to )e trained 0e&el of competencies of participants

*ndi&id%al Participant Team of doctors, n%rses and mid(i&es (ho ser&e as s5illed )irth attendants at the )irthing facilities that are capa)le of pro&iding 1?m;+ 6t least (ith e7perience in handling )irth deli&eries 1ac5gro%nd in )asic ;1=EJ! and Pediatrics ;nce the participants ha&e )een selected, a T!6 designed to determine the s5ills (hich the participants (o%ld li5e to learn or impro&e d%ring the training, as (ell as their le&el of 5no(ledge and attit%des regarding 1?m;+' The participants (ill )e as5ed to complete a T!6 form (hich (ill )e %sed )y the Training Team in impro&ing the deli&ery of the co%rse' Settin! of Schedule The sched%les for T;+T among the reso%rce persons, dry=r%n for the co%rse and act%al training sho%ld )e disc%ssed and agreed %pon early eno%gh to prepare them accordingly' *nform them immediately as soon as the sched%les are finali<ed' #e elop$ent of Course Schedule and Preparation of Trainin! Materials 6 sched%le of all the acti&ities that (ill ta5e place d%ring the 1?m;+ s5ills training co%rse sho%ld )e de&eloped )y the Training Team' This incl%des information a)o%t the o)>ecti&es, methodology, time allotted to each acti&ity and the reso%rcesC materials needed' *t is )oth a planning tool and a g%ide for the trainers' The co%rse sched%le aims to ens%re that the flo( of training is logical, the participants are a)le to effecti&ely ac:%ire and apply ne( 5no(ledge and s5ills and stay foc%sed and interested' Together (ith the co%rse sched%le, training materials s%ch as hando%ts, comp%ter=generated presentations (Po(erPoint) %sing comp%ter and 0+" or o&erhead pro>ectors, flipchart paper, photographs and models (e'g' dolls, chic5en )reast, etc') ha&e to )e prepared' 4ist of Trainin! Materials"2esources Metacards Pentel pens

Mas5ing tape 1oard 0+" and comp%ter ;&erhead pro>ector P+P!+ Man%al #ando%ts on 1?m;+ Manila paper Transparencies of presentation materials +" of Po(erPoint presentations +hal5 Pri<es for games drill e7ercises +ase st%dy hando%ts 6rm model *F )%tterflyCcan%la +hic5en )reast "r%gs and s%pplies (magnesi%m s%lphate, o7ytocin, ergometrine, dia<epam, *FC*M anti)iotics, arthemeter or :%inine *M) D%ic5 +hec5 and R6M chart +rayola Paste 6ssorted art papers ;)ser&ation tool Partograph and 0a)or chart ?7amination chart for mothers (after discharge) $lide presentations Bndressed doll Manne:%in $elf=inflating )ag Mas5 si<e 0 , 1 $%ction t%)eCs%ction de&ice 2 to(els +loc5 $5ills re:%irement hando%t Practic%m forms Patients #ospitalC)irthingClying=in facilities

Conduct 3acilitators' Meetin! for the Trainers Course 6 t(o=day facilitator@s meeting sho%ld )e cond%cted (ith core trainers to ens%re that all re:%irements of training for the didactic and practic%m phases ha&e )een prepared' The res%lt of the meeting sho%ld ser&e as )asis for doing the necessary ad>%stments or impro&ement in the training co%rse'

Conduct of the Trainin! Course

This section consists the didactic phase, practic%m phase and monitoring and e&al%ation of the act%al s5ills training on 1?m;+' The o)>ecti&es and topics of the three main parts, mod%les and specific sessions are laid o%t to g%ide the trainers and participants d%ring the cond%ct of the training co%rse' 6n appropriate mi7 of training methods that (ere %sed in pre= testing this trainers@ g%ide (as adopted to ens%re that participants reali<e the co%rse o)>ecti&es'

#idactic
1b5ecti es 1y the end of the didactic phase, participants (ill )e a)le to8 apply the principles of good care9 enhance clinical >%dgment )y identifying and prioriti<ing patients thro%gh the application of D%ic5 +hec5 and R6M9 disc%ss the impact of doing an immediate general assessment of the (oman %pon cons%ltation at the health facility9 perform an assessment and management of a (oman d%ring la)or, after deli&ery and discharge from the health facility9 recogni<e and respond to o)ser&ed signs or &ol%nteered pro)lems of mothers9 sho( ho( to care for the ne()orn9 demonstrate co%nseling s5ills on the essential ro%tine and emergency care of (omen and ne()orn d%ring pregnancy, child)irth, postpart%m and posta)ortion9 and identify comm%nity s%pport mechanisms for maternal and ne()orn health' #uration The didactic phase (ill )e cond%cted in fo%r (-) days' Methodolo!y "ifferent methods and acti&ities shall )e employed to meet the o)>ecti&es of the didactic phase, partic%larly participatory and hands=on methods' These incl%de8 lect%reC interacti&e= disc%ssions, )rainstormingCcase st%dies, gro%p (or5C e7periential sharing, demo=ret%rn demo, plenary sessions and clinical e7pos%re' The participants (ill )e pro&ided (ith the opport%nity to descri)e the s5ill, demonstrate the s5ill, practice the s5ill and &erify (hether the tas5 is )eing performed proficiently'

Module 1 er iew of B6$1C and the PCPNC Manual

To ena)le participants to %nderstand 1em;+ and the %se of the P+P!+ Man%al'

1b5ecti e Topics

;&er&ie( of 1em;+ Bse of the P+P!+ Man%al

#uration
1 ho%r and .0 min%tes Session 1?m;+ and the Bse of P+P!+ Man%al Specific ob5ecti e 6t the end of the session, the participants (ill )e a)le to %nderstand 1?m;+ and the importance of P+P!+ Man%al and its %se' Methodolo!y 2arm=%p e7ercise 0ect%re=disc%ssion Reinforcement "rill 10 min .0 min 10 min -0 min

Materials needed Metacards, pentel pens, mas5ing tape, )oard, 0+"C;#P, presentation materials and hando%ts on 1?m;+ and P+P!+ Man%al' Procedure ?7plain the o)>ecti&es and mechanics of the session to the participants9 Pro&ide each participant (ith 2 metacards, and as5 all of them to (rite their ideas a)o%t 1?m;+ and post their cards in the )oard9 $%mmari<e the contents of the metacards )y identifying patterns of responses9 6fter the s%mmary of participants@ ideas, proceed (ith the lect%re=disc%ssion on 1em;+ and rationale and design of the 1?m;+ s5ills training co%rse9 Proceed (ith the "rill on the P+P!+ Man%al )y e7plaining the importance of 5no(ing ho( to na&igate the contents of the man%al, letting the participants go o&er the g%ide, and as5ing sample topics to identify pages and clarify contents9 and $ynthesi<e the contents of the session and lin5 it (ith Mod%le 2' Refer to pages 91=98 of the Trainer@s !otes

Module . Principles of Good Care

1b5ecti e
To pro&ide participants (ith the opport%nity to apply the principles of good care to all contacts )et(een the s5illed attendant and all (omen and their )a)ies'

Topics
+omm%nication 2or5place and administrati&e proced%res Bni&ersal preca%tions and cleanliness ;rgani<ing a &isit

#uration
Session Principles of Eood +are 1 ho%r

Specific ob5ecti e 6t the end of the session, the participants sho%ld )e a)le to impro&e s5ills in applying the principles of good care' Methodolo!y 0ect%rette 2or5shop Plenary 10 min 20 min .0 min

Materials needed - pcs' manila papers, pentel pens, mas5ing tape, )oard, 0+"C;#P, P+P!+ E%ide, hando%ts and +"Ctransparencies of presentation materials on the Principles of Eood +are' Principles of Good Care The principles of good care apply to all contacts )et(een the s5illed attendant and all (omen and their )a)ies' These principles concern8 +omm%nication 2or5place and administrati&e proced%res Bni&ersal preca%tions and cleanliness ;rgani<ing a &isit