ABSTRACT
Background: A robust emergency care system is a cost-effective method of reducing preventable death and disability, especially in low-and middle-income countries. To scale emergency care expertise across the country, the Uganda Ministry of Health and Seed Global Health established the Emergency Medical Services (EMS) ECHO program. We describe the process of establishing the program in a resource-limited setting, best practices, and lessons learned in Uganda. Methods: Investigators conducted a mixed-methods evaluation to assess the initial 4 months' implementation of the EMS ECHO. We conducted pre/post-program assessments of healthcare worker knowledge, self-efficacy, and professional's satisfaction with the program. The analysis compared the differences between pre/post-test scores descriptively. Results: The EMS ECHO was initiated in November 2021. A phased curriculum was developed with the initial phase focusing on the ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) approach to the emergency patient. This phase reached 2,030 health workers cumulatively across 200 health facilities. The majority of the participants were medical doctors (n = 751, 37%), and nurses (n = 568, 28%). Majority of participants (95%) rated the sessions as informative. On whether the ECHO sessions diminished professional isolation, 66% agreed or strongly agreed. Conclusions: Similar to other ECHO program evaluation results, Uganda's EMS ECHO program improved knowledge, skills, and the development of a virtual community of practice thereby diminishing professional isolation. It also demonstrates that through a planned stepwise process, virtual learning and telementorship can be used efficiently to improve healthcare worker knowledge,skills and multiply the limited number of emergency care experts available in the country.
ABSTRACT
Background: Maternal and newborn health outcomes in Uganda have remained poor. The major challenge affecting the implementation of maternal and newborn interventions includes a shortage of skilled midwives. In 2013, Lira University, a Ugandan Public University, in partnership with Seed Global Health, started the first Bachelor of Science in Midwifery (BScM) in Uganda with a vision to develop a Master of Science in Midwifery (MScM) in the future. Objective: Evaluate results of Lira University's Bachelors in Midwifery program to help inform the development of a Masters in Midwifery program, which would expand midwifery competencies in surgical obstetric and newborn care. Methods: Lira University and Ministry of Health records provided data on curriculum content, student enrollment and internships. The internship reports of the graduate midwives were reviewed to collect data on their employment and scope of practice. Interviews were also conducted with the graduates to confirm the added skills they were able to apply and their outcomes. Findings: The critical competences incorporated into the Bachelor in Midwifery curriculum included competences to care for pre- and post-operative caesarian section patients or assist in a caesarean section, newborn care (e.g. resuscitation from birth asphyxia), anesthesia, and theatre techniques, among others. Overall, 356 students (40.2% male, 59.8% female) enrolled in the BScM program over the period 2013-2018. Annual data shows an increasing trend in enrollment. Of the 32 graduates in January 2019, 87.6% were employed in maternal and newborn healthcare facilities, and 12.4% were employed in midwifery private practice. Follow-up interviews revealed that the graduate midwives reported positive maternal and newborn outcomes and the ability to practice advanced obstetrics and newborn care skills they acquired from the training. Conclusion: There is growing interest in a graduate midwifery education program in Uganda for both male and female students. The retention of the graduate midwives in healthcare facilities gives a renewed hope for mothers and newborns, who benefit from their extra obstetrics and newborn care competences in settings where there are neither medical doctors nor obstetricians and gynecologists. Recommendations: Further, larger tracer studies of the graduate midwives to identify the kinds of obstetric surgeries and newborn care services they ably performed and their corresponding maternal and newborn health outcomes is recommended. Also recommended is advocacy for recognition of extra skills of graduate midwives by health authorities in Uganda and the region.
