Success for Maternal Newborn Care in Vietnam
From 2014-2015, Latter-day Saint Charities (LDSC) taught three courses of Helping Babies Breathe (HBB) in three remote provinces in northern Vietnam. Though the participants were very skilled and desired to perpetuate the training, most were midwives who lacked the authority to set up sustainable programs in their provinces. We met with the Department of Maternal Child Health (MCH) in the Vietnamese Ministry of Health (MOH) and recommended that HBB become the national standard, authorized from the top, with a plan to cascade the program to all providers throughout the country. The MCH agreed on the plan, but then we had no idea how to accomplish such a large task.
After trying unsuccessfully for two years, we found an organization, VietHealth, who helped LDSC form trusting relationships with the Department of Maternal Child Health (MCH). Mrs Nguyen Hong Linh from VietHealth developed a detailed plan to integrate the HBB curriculum into the Vietnamese national standard. This included the vetting of HBB in the country’s 58 provinces and five municipalities. VietHealth developed a detailed budget for this nationwide review, LDSC provided funding, and VietHealth provided oversight and direction. VietHealth also facilitated close communication with our national technical advisor, Dr Dinh Phuong Hoa, a neonatologist who translated the HBB curriculum into Vietnamese and helped the MOH realize how HBB complements their national Essential Newborn Care program. Dr Hoa and Mrs Linh were very involved in the national review and vetting of HBB and were KEY to the success of this project.
VietHealth worked closely with the technical specialists (Deb and Steve Whipple) and three successive in-country humanitarian missionary couples (E/S Noorda, E/S Thomason, E/S Holt) to maintain open communication with the MOH and Dr Hoa.
Once the HBB curriculum was approved by all each province and municipality, the Department of Maternal Child Health, and the Scientific Committee, the revised curriculum was ready for a national training in Hanoi. This began with a two-day national training for 38 neonatal experts from national hospitals all over the country. The participants were individually invited by the MOH who gave opening remarks indicating the Ministry’s endorsement of the HBB program. The MOH gave statistics of Vietnam’s neonatal mortality in comparison with other countries in Asia and gave the participants a mandate to use HBB to train providers to help save newborn lives. These trainers from national hospitals were also given the responsibility to cascade the HBB trainings to all in-country providers, subsequent follow-up, and mentoring programs directed by the MOH.
The initial HBB training in Hanoi was an introduction of the HBB training format with a discussion of the national perpetuation plan. Both Dr Hoa and Mrs Linh were instrumental in facilitating these discussions. In the end, the participants understood their responsibility to train providers at district and commune levels and how the basic Helping Babies Breathe curriculum would decrease their workload in the provincial and national NICUs by improving neonatal outcomes at birth.
We are now implementing the HBB training in the 58 provinces throughout Vietnam. These courses are directed by two national trainers and two provincial trainers, previously trained at the national training in Hanoi. The provincial courses include 14-16 participants, invited by the Provincial Department of Reproductive Health. The leaders of the National Department of Maternal Child Health travel to each province to speak at the opening ceremony, endorse the HBB program as a national standard, and empower the participants to take seriously their responsibilities as provincial trainers.
The format for the provincial trainings is different from what we have previously done and it has been a paradigm change. Recommended by Dr Hoa and Ms Linh, the provincial trainings focus on building the capacity of a core group of national and provincial trainers. The HBB training lasts four days: two days of HBB training, evaluation, perpetuation planning, sustainability and teaching tips. The next two days are dedicated to Supportive Supervision lessons focused on effective communication and how to become excellent trainers. The inspirational Supportive Supervision discussions were developed and taught by Mrs Linh and Dr Hoa. Training concepts taught through PowerPoint lessons and group discussions are enhanced through large and small group activities with applicable object lessons. Each small group is assigned to prepare one of the HBB lessons and present it to the class. Positive feedback and constructive ideas for improvement are given using concepts learned during the day. In the end, everyone learns ways to improve their teaching skills and implement supportive supervision during subsequent trainings, provider mentoring and program evaluations.
At the end of the fourth day, assignments are given, team leaders appointed, and detailed plans are made for subsequent provider trainings to be held within a few days and weeks of the master training while enthusiasm is high. The plan includes dates for district trainings to be completed within two months. These trainings are taught under the oversight of VietHealth leadership. LDS Charities pays for the registration materials, lunches for participants and per Diems for the provincial trainers and support staff. The MOH is responsible for training HBB in the communes (small clinics).
Paying an organization to facilitate a relationship with the MOH, plan and implement the HBB trainings, and follow-up with the cascading and sustaining of the program has been essential in Vietnam. In the past, we have been discouraged from paying partners for facilitating and following up on evaluation, mentoring and sustainability. After observing VietHealth in action, seeing their networking with the MOH, and observing their understanding of how things work in Vietnam, we feel using an implementing partner is the proven way for the LDSC model to make a sustainable difference.
The model of a small core group of national trainers (6-10) working to train small groups of provincial trainers (14-16) works very well in Vietnam. It produces strong, dedicated trainers who are responsible for provincial cascading, refresher courses, mentoring and evaluation.
This pattern has been successfully replicated in several provinces throughout Vietnam with the plan that it will become a model for other NGOs teaching HBB in Vietnam.
Submitted by Deb and Steve Whipple