Sector Wide Approach to Strengthening Health ( SWASTH )

Bihar Technical Assistance Support Team (BTAST)
Government of Bihar initiative supported by Department for International Development, UK


Skills Labs help nurses and doctors learn and serve better

Two Skills Labs in Bhagalpur and Muzaffarpur districts of Bihar conduct RMNCH+A prescribed six-day training programmes for improving the skills of nurses and doctors in maternal and child health

Skill sets of health care professionals are crucial for delivering quality services. To enhance proficiency of doctors and nurses, two Skills Labs have been set up in Bihar under the Department for International Development (DFID-UK) funded Sector Wide Approach to Strengthening Health (SWASTH) programme. 
The Skills Lab at the Jawahar Lal Nehru Medical College and Hospital (JLNMCH), Bhagalpur district, which aims at strengthening the public sector health system in the state, is aligned to the Government of India’s Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) strategic approach. 
The training follows a six-day curriculum for improving the skills of providers in practice and is divided into demonstration and knowledge sessions on topics related to maternal and child health. In hands-on sessions, participants practise on mannequins, conduct simulation exercises, and learn through demonstration videos and presentations. The theory sessions focus mainly on skilled birth attendance, Integrated Management of Neonatal and Childhood Illness, and the Navjaat Shishu Suraksha Karyakram curriculum. 
The Skills Lab has skill stations for two levels – basic and advanced. There are 38 skills under basic and 13 skills under add-ons. The basic training conducted in the Skills Lab is for service providers like General Nurse Midwives, Auxiliary Nurse Midwives, Staff Nurses, Nursing Supervisors and Medical Officers who are key to delivering RMNCH+A services and are posted at ‘Delivery Points’. 
All States & Union Territories have identified Delivery Points above a certain benchmark of performance to prioritise and direct resources in a focused manner to these facilities for filling gaps like trained and skilled human resources, infrastructure, equipments, drugs and supplies, referral transport, etc., for providing quality & comprehensive RMNCH+A services. 
The add-on skills are meant for service providers like medical officers, obstetricians & gynaecologists, and selected nurses, who are posted at First Referral Units, 24x7 Primary Health Centres and higher facilities.
Skills Lab Master Trainer, Princy P Samuel says, “The nurses are trained in ante-natal, intra-natal and post-natal care. No doubt, this training should be mandatory for all in-service nurses as it helps them in enhancing their skills.”
Significantly, the Skills Lab training has also been incorporated in the nursing education programme for pre-service trainees and trainee nurses from the nursing school attached to the hospital. Additionally, the Skills Lab provides facilities for Continuing Nursing Education and Continuing Medical Education. Concerted efforts by various stakeholders and the considered set-up of the Skills Lab has ensured optimal utilisation of its facilities.
Safina Toppo, a Master Trainer at the Skills Lab in Bhagalpur, adds that the nurses are also trained on biomedical waste management and infection control. “The nurses enrolled at the Skills Lab go through several practice sessions that make them confident in delivering better results in the field,” she says.
The training sessions are interactive and participatory and trainers proactively initiate dialogue with participants. Dr Om Prakash Prasad, Regional Additional Director, Bhagalpur, says that Skills Labs are crucial for any Auxiliary Nurse Midwife (ANM) to learn as practical demonstrations are not done at the district level. “Four mandatory ante-natal care (ANC) checks-ups are key to safe pregnancy and to prevent any complications during childbirth. If four ANC check-ups are done, then there is a high chance of the mother and the child being healthy. The Skills Lab is a safe space for ANMs to learn how to carry out ANC check-ups correctly,” he says.
Deepshikha, a staff nurse hailing from Bahadurgarh in Bhagalpur and working at JLNMCH, says that the six-day-training she received at the Skills Lab has helped her to extend much needed services to both the mother and the child. She says, “Enhancing my skills related to ante-natal, intra-natal and post-natal care, which are crucial in this field, has made me more confident and equipped me with the knowledge to serve better the mothers and children who come to me in need. For example, I am better equipped and feel competent in the use of partographs to monitor the well being of a pregnant woman.”
In the same vein, staff nurse Kirti Kiran Murmu who hails from neighbouring Jharkhand, says that the training has improved her counselling skills, which she has to use often in her job as a nurse. “We now understand the significance of routinely counselling mothers of newborns on topics like exclusive breastfeeding for the first six months and other precautions that need to be followed when taking care of a newborn,” she says. At the universal precaution skill station, she claims to have got a thorough understanding on the basic requirements for assisting childbirth - like hand-washing, preparation of chlorine solution, personal protective attire, and sterilisation.
Talking about the training at the Skills Lab, Vibha Kumari, staff nurse at JLNMCH Bhagalpur, says that skills acquired at the lab are crucial for preventing mothers and newborns from getting infections. She adds, “We have been given demonstrations on cervical dilatation and normal childbirth. But we have also been taught decontamination, cleaning, sterilisation and storage.” 
Dr Vijay Kumar, Civil Surgeon, Bhagalpur, says that the skill building of health personnel is a must for delivering quality health care. “It’s necessary for proper health care management that the professionals know their work. Therefore, skill building of health personnel like nurses should be the first priority for any state and not just Bihar,” Kumar adds.
Arun Prakash, Regional Programme Manager, State Health Society-Bihar, Bhagalpur, says that the Skills Lab has brought efficiency in post-partum management. 
He adds that most government nurses are not aware of basic practices of the labour room. “Every labour room has a newborn centre with essential equipment like vacuum and suction machines, oxygen and ambulance bags. Nurses should be able to handle this equipment. Various skills like the method for infusion of fluid in the body are crucial for performing basic duties like ante-natal care, post-natal care, and immunisation of children as per the laid down schedule,” he says. 
Giving an overview of the training programmes, Mithilesh Kumar, Manager, Skills Lab, Bhagalpur, says that 40 batches of nurses were trained in the first year since the Skills Lab started in March 2013. In the last two years, from July 2013 to August 2015, the Bhagalpur Skills Lab has trained 1,246 participants in 88 batches. 
The Skills Lab at JLMNCH is a regional training hub for the Bhagalpur division and covers 13 districts. Similarly, the Muzaffarpur Skills Lab covers 11 districts. Human resources for health are critical to quality of care and given the challenges in the health sector in Bihar, the state needs many more Skills Labs like the ones established under SWASTH with BTAST support.
The SWASTH programme aims to improve the health and nutritional status of people of Bihar by increasing access to better quality health, nutrition, and water and sanitation services particularly for the underserved groups. The focus of this programme is to strengthen the systems through better planning, organisational strengthening & human resource management, decentralisation and convergence among key departments. The programme also uses community level processes to manage, demand and monitor services. 
Two Skill Labs have been set up in Bhagalpur and Muzaffarpur established by the Government of Bihar with the support of the Bihar Technical Assistance Support Team (BTAST) and the Department for International Development (DFID-UK) under the Sector Wide Approach to Strengthening Health (SWASTH) to improve the health and nutritional status of people in the state. The Skills Labs conduct six-day training programmes to build the capacities of frontline health workers like nurses and doctors in maternal and child health. 
This story was written by Ashok Kumar at OneWorld Foundation India. 
Disclaimer: SWASTH is supported by the Department for International Development (DFID)-UK and implemented by the Government of Bihar, in collaboration with the Bihar Technical Assistance Support Team. However, the views expressed in this report do not necessarily reflect either DFID’s or Govt. of Bihar’s official policies or views.