Implementation Guide July 2016 - Jhpiego
Implementation Guide July 2016
HMS Implementation Guide Draft v 2 (July 2016) C opyright Jhpiego Corporation, 2016. All rights reserved.
Table of ContentsIntroduction to HMS01Bleeding after Birth Basics02Program Design and Planning03Program Implementation04Program Monitoring and Evaluation05Annexes06
This implementation guide was made possible through funding from the Laerdal Foundation for Acute Medicine. Itwas created by Jhpiego, particularly Stephanie Suhowatsky, Cherrie Evans, Sara Chace, Jen Breads, Laura Fitzgerald,Bernice Pelea, Megan Wysong, and Connie Lee. Editing, formatting, and graphic design support was provided byAlisha Horowitz and Young Kim. Special thanks to all our excellent HMS trainers around the world who reviewedearlier versions and provided feedback.
Abbreviations and Acronyms AMTSLActive Management of Third Stage of Labor BABBleeding after Birth BEmONCBasic Emergency Obstetric and Newborn Care C CTControlled Cord Traction C EmONCComprehensive Emergency Obstetric and Newborn Care DHODistrict Health Office EmONCEmergency Obstetric and Newborn Care EONCEssential Obstetric and Newborn Care HMISHealth Management Information System HMSHelping Mothers Survive HRHHuman Resources for Health IRBInstitutional Review Board L&DLabor and Delivery LDHFLow Dose, High Frequency LOELevel of Effort M&EMonitoring and Evaluation MNHMaternal and Newborn Health ModCAL Modified Computer-Assisted Learning\
Abbreviations and Acronyms (continued) MOHMinistry of Health MOUMemorandum of Understanding N GONongovernmental Organization OJTOn-the-Job Training OSCEObserved Structured Clinical Examination PPHPostpartum Hemorrhage QIQuality Improvement SBASkilled Birth Attendant TAGTechnical Advisory Group USAIDU.S. Agency for International Development UUIFBUterotonic Used Immediately Following Birth WHOWorld Health Organization
Section 01 Introduction to Helping MothersSurviveAn overview of the HMS approach, including thebasics of district implementation Introduction to this Guide HMS Strategic Approach HMS at the Health Facility Developing HMSTraining/Mentoring Capacity HMS Summary
section 01About this Implementation GuideThe Helping Mothers Survive (HMS) Program aims to improve maternal and newborn care (MNH)skills among midwives, nurses, doctors, and other health care providers. At scale, HMS can improve theclinical practice in places where preventable deaths continue to occur.This guide shares theessential informationand provides thereader with resourcesto be able to designand implement HMS ina low-resource setting.Contact us at hms@jhpiego.orgwith questions aboutimplementing HMS and to shareyour experiences.HMS uses a single to several-day, facility-based learning approach that is followed by short, frequentpractice sessions to reinforce skills. The first module in the HMS suite developed in 2012 and tested in2013—Bleeding after Birth (BAB)—prepares health care providers to prevent and managepostpartum hemorrhage (PPH). Having demonstrated the effectiveness of the training approach,additional modules were developed to target other causes of maternal death. The task ahead is toimplement HMS in countries where maternal mortality and morbidity remain unacceptably high. Thisguide will focus on the BAB as an example module of the HMS approach, however the principles areapplicable to all modules in the suite. For more information about HMS:§ Helping Mothers Survive website: www.helpingmotherssurvive.org§ Helping Mothers Survive Bleeding after Birth demonstration Video (You Tube)§ Laerdal Global Health: rs-Survive-BleedingAfter-Birth§ ReprolinePlus: e-bleeding-after-birth-trainingpackage8
section 01HMS BABGetting Started: Using this Guide This guide has been developed to help introduce, integrate, and scale up HMS in low-resource settings. Itfamiliarizes the user with HMS approaches, using the BAB module to present concrete examples of how torapidly design, plan, implement, and monitor a HMS training program—along with links to available resources. urpose: To provide straightforward, step-by-step guidance onPhow to design and implement HMS Users: Program managers, technical advisors, and master trainers Structure: Sections provide general programming guidance anddirect the reader to additional tools and resources. Tools and Resources: The guide provides a number of materialsto help implement HMS and for BAB programs:§ On a USB drive that accompaniesthis guide§ On the HMS websitehelpingmotherssurvive.org (alsofound on reprolineplus.org)Look at Annex A forthe full list of tools& resources9
section 01Helping Mothers Survive Helping Mothers Survive (HMS) is a package of targetedcapacity building modules delivered through a simulationbased learning approach to build and sustain competenciesof the health workforce in countries with high burdens ofmaternal mortality. HMS was developed by Jhpiego, in collaboration with Laerdal GlobalHealth, The International Confederation of Obstetricians andGynecologists (FIGO), International Confederation of Midwives (ICM),International Council of Nurses (ICN), UNFPA, and the AmericanAssociation of Pediatrics (AAP). It aims to improve and sustain critical MNH skills of midwives, nurses,doctors, and others. It is targeted to address the leading causes ofmaternal and neonatal mortality—to end preventable deaths. 1 Ending Preventable Maternal Mortality: USAID Maternal Health Visionfor Action , June 20142 Every Newborn,An Executive Summary for The Lancet’s Series, May 2014HMS Mandate§ Equip all providers who care for women andnewborns with knowledge and essentialskills to prevent and manage the majorcauses of maternal and neonatal mortalityglobally.§ Focus on improving quality of care on theday of birth—because over 40% of maternaldeaths occur in the first 24 hours after birth.2§ Scale an evidence-based learning andmentoring approach to improve andmaintain the competencies of health careproviders.10
section 01HMS: ModulesAvailableBleeding After Birth(BAB)Pre-Term BirthNear Final, Available 2016Pre-Eclampsia &EclampsiaBleeding After BirthPlus (BAB )Under Development, 2016–2017Labor &BirthComplications ofLabor & Birth While focused on maternal health, HMS modules cover clinical competencies which affectnewborn outcomes. HMS also considers the mother and newborn as a pair so newborn care isintegrated where appropriate.F or newborn health, a similar series of Helping Babies Survive (HBS) modules have beendeveloped, focused on newborn care. Available modules include Helping Babies Breathe (HBB)(www.helpingbabiesbreathe.org) and Essential Care for Every Baby nitiatives/global/Pages/eceb. aspx). This guide highlights where there are natural synergies between HMS and HBS modules, such asfor intrapartum care, and provides suggestions on how they can be integrated duringimplementation.See Annex B for aspecific example11
section 01Helping Mothers Survive HMS is designed to change the practices of health care providers by increasing their knowledge, skills,attitudes, and confidence. It also catalyzes support and a sense of teamwork among the staff who providematernal and newborn care within a health facility. This graphic summarizes the key elements of HMS thattogether help create changes in practice. The ability of HMS to change practices has value added forMNH programs because it complements and extends thereach of:Mother andnewborn area unitSharedfacilitationof practice*Train ALLauthorizedprovidersChange orsConcise1. Quality improvement (QI) efforts to improvematernal and newborn care services at health facilities.Skilled providers are critical to deliver quality care toevery pregnant woman, mother and newborn.2. Competency-based training programs, particularlyin-service training (such as essential obstetric andnewborn care [EONC]). HMS also can be integrated into pre-service education. * HMS uses a low-dose, high-frequency (LDHF) approach to the shared facilitation of practice, whichis described indetail laterin this section.12
section 01Helping Mothers Survive:Who is trained? All health care providers* authorized to provide maternal and newborn care can benefit from HMS training.Within a facility, they are all trained together as a team. Skilled birth attendants (SBAs) can specifically benefit from HMS training in related advanced care.Non-SBAs who assist withbirth (nursing assistants,health orderlies) * *HMS is not designed for traditional birth attendants.SBAs—midwives, nurses, auxiliarynurse midwives, doctorsOther providers who managecomplications (doctors, clinicalofficers, medical assistants,specialists)13
section 01Helping Mothers Survive:The HMS approach to maternal and newborn careLifesavingFocusedPracticalTargets the leadingcauses of maternaland neonatal deathPrimarily focused on theintrapartum period whenmost deaths occurEvidence-based actionplans simplify care forhealth care providersHMS can be a useful tool toglobal and country-specificprograms to further reducematernal and neonatalmortality.HMS improves care on the dayof birth—for both mother andbaby. HMS integrates care andpromotes survival.HMS materials are simple,highly intuitive, and graphic.HMS teaches simple ways toprevent, recognize, andrespond to problems.14
section 01Helping Mothers Survive:The evidence for HMS The HMS approach was shaped by key findings from a 2011 Jhpiegoliterature review 3 that identified effective training approaches forcontinuing professional education for health workers (i.e., in-servicetraining).§ argeted, repetitiveTinterventions result in betterlearning outcomes. Training on-site at the provider’sworkplace results in sustainedknowledge and skills.The most effective educational techniques to improve and sustainknowledge and skills acquisition and maintenance are:§ Case-based learning,§ Clinical simulations, and§ Practice and feedback.§Passive instruction—such as reading or lecture—have little or noimpact on learning outcomes or improving clinical practice.§Repetitive interventions, rather than single interventions, are betterfor learning outcomes.§Settings in or closest to the workplace improve skill acquisition andperformance.These findings together provide clear recommendations on how toimprove training for greater impact on learning and performance.3Bluestone J, Johnson P, Fullerton J, Carr C, Alderman J, Bontempo J. Effective in-service training design and delivery: evidence from an integrative literaturereview. Hum Resour Health. 2013. 11(1):51.15
section 01Helping Mothers Survive:Low-dose, high-frequency approach C apitalizing on these findings, the HMS capacity building approach is designed to more effectively change thepractices of health care providers. HMS facility-based learning and practice are powerful and innovative because ofthe low-dose, high-frequency (LDHF) approach. It is the principle of LDHF that is essential to HMS design andimplementation.PART 1: HMS TRAININGOne-day HMStrainingWeeklypracticesessionPART 2: LDHF FACILITATED PRACTICE ion HMS one-day clinical Following the one-day training, a series of weekly LDHF practice sessions using clinicaltraining emphasizessimulation usinganatomic models, roleplay, and case-basedlearning opportunities.simulations are conducted in the workplace to reinforce lifesaving practices. During theweekly session, each health care provider practices key skills for 10–15 minutes with apeer. Practice options include: skills practice, scenario session, games, and teamsimulation.LDHF within HMS is not prescriptive in terms of numbers of sessions or the minimumnumber of hours, although some guidance is provided within each module. The key tosuccess is that practice is facilitated by a “Peer Practice Coordinator” or “Clinical Mentor” tohelp ensure all providers practice.16
section 01Helping Mothers Survive:Other key elements of HMS training approachHands-onOn-siteLearning through case studies,role plays, skills stations, andclinical simulationsLearning and practice in thehealth care provider’s facilityimproves performanceHMS uses a simulation-basedtraining approach that enableshands-on learning for skillsacquisition and repeatedpractice, while also improvingprovider knowledge.Evidence shows that using healthworkers’ daily work environment asthe classroom improves learningand changes in practice. HMSreduces service disruptions due tooff-site training.Team-orientedLearning and practicingtogether ensures all healthcare providers are readyIdeally, all providers andsupervisors involved in labor andbirth in the facility join the HMStraining and practice sessions. Thisstrengthens teamwork andcommunication, which are criticalduring emergencies.17
Sub-section01-1 HMS at a Health Facility snapshot of HMS training and LDHF practice as it isAimplemented at a health facilityIf you are alreadyfamiliar with HMS,skip ahead toSection 2.
section 01Helping Mothers Survive:HMS in a health facilityPART 1: HMS TRAININGOne-day training for all staff who areinvolved in labor and delivery services,conducted by a HMS Trainer.HealthcenterPART 2: LDHF-FACILITATEDPRACTICE SESSIONSWeekly practice session or clinical simulation, basedon a pre-defined scenario and organized by a ClinicalMentor.HMS Champions training is conducted forall authorized providers and support staffbased on module content.Each trainer is assigned several facilities.S/he visits each facility for HMS on-site learning. Thetrainer brings the HMS materials.* Each trainingshould have no more than six participants (i.e., a ratioof one trainer to six providers). Larger groups needadditional trainers, or multiple HMS Championstrainings can be scheduled. Providers, support staff,and supervisors or in-charges are trained as a team soroles are clear. * Some modulesus e a clinical s imulator (s ee AnnexH for informationon s imulatorsfor HMS BAB-relateds imulators ).Two Peer Practice Coordinators ateach facility are selected andoriented.After HMS Champions training, the trainerspends a day with two Clinical Mentors toorient them to the role as facilitator of theLDHF phase. The Practice Coordinators aregiven weekly practice session plans and asimulator if needed.The Practice Coordinators organizeonce-weekly practice after HMStraining (e.g., eight weeks for HMSBAB).Either Coordinator runs practice sessions or clinicalsimulation individually or in groups each weekwith all providers. For example, a practice sessionhas each provider practice for approximately 15minutes, based on a pre-defined scenario.19
section 01HMS:LDHF Practice at a Facility, HMS BAB exampleHealthcenterOne-day ionWeeklypracticesessionWeeklyteamsimulation Week 1: Prevention of postpartum hemorrhage (PPH): activemanagement of third stage of labor (AMTSL) and review oftransport planWeek 2: Atony resolving with massage and medicationWeek 3: Atony requiring bimanual uterine compressionWeek 4: Team simulation—atony requiring bimanualuterine compressionLDHF weekly practice s es s ions are illus trative and us e the s ix developed LDHF s es s ions plans developed by WeeklypracticesessionWeeklyteamsimulationWeek 5: Retained placenta resolving with continuedcontrolled cord traction (CCT)Week 6: Retained placenta requiring transferWeek 7: Retained placenta that resolves and thenbecomes atony, resolving with massage and medicationWeek 8: Team simulation—retained placenta requiringtransfer20
Sub-section01-2 Developing HMS Training/MentoringCapacity Details on the roles needed to provide HMS in health facilitiesand how they are developed, including: Training/Mentoring Roles HMS Champions Master Trainer and Trainer Preparation Peer Practice Coordinators OR Clinical Mentors
section 01HMS Training/Mentoring RolesI advocate for moreeffective ways to trainproviders, improvequality, and save lives!HMSAdvocateI use my HMStraining daily tocare for womenand newborns.MNHProviderROLE Nationaladvocate Provider or anationaladvocate May bepreparing forHMS Trainer roleQUALIFICATIONS ProficientMNHprovider orstakeholderfor MNH* Trained asHMSChampion Proficient MNHprovider Trained as HMSChampion * The HMS Champions cours e is des igned for clinically active providers , but s takeholders (e.g., Minis try of Health officials , development** Jhpiego training pathway or other pathway recognized by a country’s national training board/organiza tio n.partners ) participate.I organize theweekly practiceand simulationsfor my coworkers.Now I am goingto a facility totrain providers.Peer PracticeCoordinator/ClinicalMentorI am ready to trainHMS Trainers!HMSTrainerHMS MasterTrainer Provider and facilityadvocate Coordinates andrecords LDHFpractice Coordinates withHMS Trainer District advocate Training of providers:conducts HMS Championstraining in a facility Facilitates selection ofclinical mentors Supports LDHF practice National advocate Trainer of trainers for HMS BAB Monitoring and evaluation (M&E)guidance Training commodities support Proficient MNHprovider Trained as HMSChampion Trained/mentored Oriented as clinicalmentor The title should suitthe local context Proficient MNH provider Trained as HMSChampion Qualified trainer** Trained as HMS Trainer Mentored as HMS Trainer Trained in clinical mentorselection, training, andmentoring Proficient MNH providerTrained as HMS ChampionTrained as HMS Master TrainerMentored as HMS MasterTrainer** Positioned (professionalassociation, nongovernmentalassociation [NGO], governmentcouncil)22
section 01HMS Champion Training:The gateway to HMSAt the heart of an HMS program are its Champions. All HMS programs start with the one-day HMS ChampionTraining. This is the basic provider course, and all who successfully complete it are HMS Champions. Thecourse is for health care providers of all types who care for women during birth, their supervisors, and those whoadvocate for quality maternity services. Providers, maternal health advocates, Peer Practice Coordinators / ClinicalMentors, future HMS Trainers, and Master Trainers all begin their involvement in HMS programs as Champions.We are ALL HMS Champions!Who is an HMS Champion?An individual who is highly committed to significantly reducing preventablematernal and neonatal mortality—most often a health care provider who cares forwomen and newborns at birth.HMS Champions are primarily clinically active MNH care providers who use their newskills to provide services, but can include advocates and stakeholders who want tounderstand HMS better and promote its use.HMS Champions become part of a global HMS Alumni network (database) and maybe contacted for updates on HMS progress within their community.23
section 01The HMS Champion TrainingExample from HMS BAB The one-day HMS Champion ObjectivesDesignTraining presents the HMSapproach to capacity building,provides clinical updates, orientsusers to simulation for learning,and provides participants with The course objectives include:The one-day HMS Champion course remains thesame whether it is run to launch an HMS program,to train health care providers at a facility, or toprepare a group of HMS Trainers.hands-on practice. The training uses a number of methods, includingrole plays, demonstration, and returndemonstrations using simulators and local suppliesand teaches clinical care algorithms based on HMSAction Plans. The first Champion course in a project or country istypically conducted to launch HMS and is oftenheld as a workshop for advocates and trainers.§ Understand the principles of HMS training§ Demonstrate the clinical care and decisionmaking for the clinical topic —all according tostandards§ Understand the importance of LDHF practice atthe facility after trainingWhat differs is the training participants (the“audience”), AND if there are other workshop daysadded to the original one-day training (forplanning, facilitation support, mentoring, etc.).Trainer: Participant RatioOne trainer to no more than six participants.It is important to keep six or fewer participants pertrainer so everyone has time for practice and theobserved structured clinical examination (OSCE)Interested in participatingin an HMS ChampionTraining?Interested in running anHMS Champion Training?Contact ushms@jhpiego.org24
section 01After the HMS Champion TrainingHMS Champion TrainingAdvocatesReturn to work andeducate policymakers,educators, clinicians,health administrators, andmembers of professionalassociations regarding thevalue of the HMS trainingapproach.MNHProvidersReturn to work andadopt HMS-relatedskills into careprovision at the facility.MNH providers alsoshare HMS learningwith their peers. The HMS Championsadvocate for LDHFpractice to maintainhealth care providers’skills.* To become an HMS Trainer, individuals mus t be recognized by their profes s ional ** To be preparedPeer PracticeCoordinators/ClinicalMentorsParticipate in a one-dayorientation to facilitateLDHF practice ofessential skills for coworkers.Return to work andorganize and facilitateweekly HMS practicesessions or drills at thefacility with all providersindividually or in teams.group as a Trainer. If not a certified Trainer, complete Modified Computer-As s is tedas HMS Mas ter Trainers , individuals mus t be recognized by their profes s ionalCandidate HMSMaster TrainersCandidateHMS TrainersParticipate in HMS facilitationtraining immediately followingthe Champion training.*Participate in HMS facilitationtraining immediately followingthe Champion training.**After HMS facilitation training,a Candidate HMS Trainer issupported by an HMS MasterTrainer to conduct an HMSChampion training. They arementored and supportedthroughout the day, and thenrecognized as an HMS Trainer.Similar to HMS Trainers, afterHMS facilitation training,candidates conduct their firstHMS Champion training forHMS Trainers while beingmentored throughout the day.Learning (ModCAL ) online, http://reproli ne plus .o rg /lea rni ng -o ppo rt uni ties /cou rs e/ m odcal -tr aini ng -s killsThen they are recognized asHMS Master Trainers.(s ee next page for details ).group as a Mas ter Trainer.25
section 01HMS Trainer Development:After the HMS Champion TrainingCandidateHMS TrainerIf not already a certifiedtrainer, ModCAL is neededbefore mentoringModifiedComputer-AssistedLearning (ModCAL ) FacilitationSupportTraining (one day)FacilitationSupportTraining (one day) Co-conduct HMS BABChampions Trainingfor Providers,with a MentorNow I am goingto a facility totrain providers.Co-conduct HMS BABChampions Trainingfor Trainers,with a MentorFacilitatorsOrientationfor Trainers,with a MentorI am ready to trainHMS Trainers!HMSTrainer * To becomean HMS Trainer, individuals mus t be recognized by their profes s ional group as a Trainer. If not a certified Trainer, complete Modified Computer-As s is ted** To be prepared as HMS Mas ter Trainers , individualsmus t be recognized by their profes s ionalOnly chosen if alreadyrecognized by their professionalgroup as someone who isqualified to train trainers (i.e.,already a “Master Trainer”)Candidate HMSMaster Trainergroup as a Mas ter Trainer.HMS MasterTrainerLearning (ModCAL ) online, http://reproli ne plus .o rg /lea rn in g-o pp or tu nities /co urs e / mod cal-t rai nin g-s kills26
section 01Qualifying Trainers through MentoringMentoring is critical to the design of HMS, and without it the effectiveness of the training cascade greatlydiminishes. Mentoring as a part of developing and qualifying HMS Trainers and Master Trainers is not optional—it isessential to the design and implementation of HMS programs. For example, a candidate HMS Trainerconducts an HMS Champion training withthe support of a Master Trainer. The MasterTrainer helps prepare, guides the HMSCandidate Trainer, answer questions, andprovides an extra set of hands whenneeded during the training day.HealthcenterHMS Master CandidateTrainerHMS TrainerAfter the training is over, they debriefabout the day and if the Master Trainerfeels confident that the HMS CandidateTrainer can independently conduct theHMS Champion course and orient thepractice coordinators/clinical mentors, theHMS Candidate Trainer is qualified.The candidate HMS Trainer conducts the HMS Championtraining at a facility for providers while being mentored onsite.The HMS Master Trainer observes, provides support and feedback, andultimately qualifies the HMS Trainer at the end of the day.27
Well-prepared, motivated Practice Coordinators are critical to HMS success. It does not matter what title is used andthis can be based on local preference. Although the word “mentor” often refers to a senior, experiencedprofessional guiding junior staff, in this role Clinical Mentors or Peer Practice Coordinators serve more as a facilitatorto make sure the LDHF practice sessions occur each week and that all staff participate. Two are chosen to makepractice easier and to help manage staff transfers. Practice can be scheduled or it can be opportunistic and occurwhen staff are not busy.MNHProvider Immediately following the facilitybased HMS Champion trainingHMS recommendstwo PracticeCoordinators areselected and orientedper facility.Practice CoordinatorOrientation (one day)I organize theweekly practiceand simulationsfor my coworkers.HealthcenterClinicalMentorOne-day sessionWeeklyteamsimulation28section 01HMS Peer Practice Coordinator / Clinical MentorDevelopment
section 01HMS Summary This first section introduces the key HMSconcepts and approaches that together createchanges in practice. This initial orientation toHMS provides the context for thinking abouthow HMS can fit into existing programs thataddress the leading causes of maternal andneonatal mortality. More detail is provided in the next sections of thisguide to assist in the development of HMS activities. Please also review the annexes for additionalresources, such as glossary of terms.One-day sessionWeeklyteamsimulation29
Section 02 Bleeding after Birth Basics The First HMS Module Key Interventions HMS BAB Resources
section 02Helping Mothers Survive:Bleeding after Birth Bleeding after Birth is the first module in the Helping Mothers Surviveseries. The first HMS module focuses on prevention and management of PPH—theleading cause of maternal mortality globally. In Africa and Asia, PPH contributes toapproximately 30% of maternal deaths.4 Many of these deaths can be averted through AMTSL. The HMS training packageclearly outlines the evidence-based practices for AMTSL in a visual Action Plan,which is used during training and as a support tool for decision-making duringclinical care.See Annex D formore PPH-relatedinformation5World Health Organization(WHO) recommendations for the prevention and treatment of PPH, 2012.31
section 02PPH:Key InterventionsAction PlanTo make internationally-accepted clinical recommendations on PPHprevention and management5 more accessible and actionable forhealth care providers (and to reinforce prior learning), HMS BABtranslates global recommendations into a simple, visual action plan.HMS BAB combines provider-focused, action-oriented materials with anapproach that simulates clinical experiences so providers can practiceand prepare for PPH emergencies.Recommendations from WHO, ICM and FIGO:§ Use a uterotonic immediately following the delivery of thenewborn, preferably oxytocin.§ Delay cord clamping for 1–3 minutes following birth.§ Utilize CCT to deliver the placenta if desired.§ Assess uterine tone to identify uterine atony.§ Give a second dose of oxytocin in the case of retained placenta.§ Give a second dose of uterotonic in the case of atony. 5 WHO, 2012; Lalonde, A. Prevention and treatment of postpartum hemorrhage in low-resource settings. International Journal of Gynecology and Obstetrics 117 (2012) 108–11832
section 02HMS: BAB Advanced CareAction PlanFor situations where PPH is not managed with BAB skills and womenneed advanced care, HMS has developed an additional module toextend training. The BAB Advanced Care module makes WHOrecommendations on PPH prevention and management5 part ofcomplementary learning materials that are visually accessible for healthcare providers in these emergency situations.This module completes the skills set for basic emergency obstetric andnewborn care (BEmONC) and includes selected comprehensiveemergency obstetric and newborn care (CEmONC) interventions.BAB Advanced Care for PPH:§ Shock management—including IV infusion and catheterization§ Aortic compression§ Repair of vaginal and cervical tears§ Manual removal of the placenta§ Use of a intrauterine balloon tamponade and non-pneumatic antishock garment33
section 02HMS BAB ResourcesTo see HMS BAB materials and understand how the clinical simulator works, take a moment to look online at theHelping Mothers Survive website, helpingmotherssurvive.org Helping Mothers Survive Bleeding after Birth materials Training materials consist of the Provider’s Guide, Action Plan poster, andthe Flipbook. Materials currently are available in English, French, Portuguese, Russian,Hindi, and Swahili. English materials are available in two versions, withgraphics appropriate for African or South Asian settings. http://reprolineplus. org/resources/helping-mothers-survive-bleedin
2013—Bleeding after Birth (BAB)—prepares health care providers to prevent and manage postpartum hemorrhage (PPH). Having demonstrated the effectiveness of the training approach, additional modules were developed to ta
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