Beyond the hospital walls
The Centre for Excellence, established at a district hospital in Uttar Pradesh, India, provides training for healthcare workers that extends beyond the hospital walls and reaches community health centres.
Posted on November 15, 2023
For the past 24 years, Sushila Devi has worked as a staff nurse at the Chaukaghat Community Health Centre (CHC) in Varanasi, Uttar Pradesh, India. Throughout this time, she’s noticed that breastfeeding was delayed for C-section deliveries, in comparison with vaginal births. Breastfeeding within one hour of giving birth is a proven practice that prevents neonatal deaths. But the timely initiation of breastfeeding isn’t a guarantee – it often requires guidance and support.
To help address this challenge, Sushila attended a training session at the Centre of Excellence in Pt. Kamalapti Tripathi District Hospital in Chandauli that equipped her to support breastfeeding within an hour of birth, regardless of how the baby was born.
In 2019, the Government of Uttar Pradesh and district officials established the Centre of Excellence for maternal and newborn health with support from Nutrition International. It has a dual-purpose mission to directly provide enhanced services for patients who visit the hospital while also being a training ground for healthcare providers from different facilities across the district. Sushila is one such staff nurse who has participated in training at the facility.
The CHC where Sushila works is over an hour away from the Centre of Excellence, so she’s brought her learnings back to her patients and her community. She educates new mothers on the significance of breastfeeding within one hour of giving birth (timely initiation), exclusive breastfeeding for the first six months, correct positioning, and secure attachment. She engages patients’ families and educates staff members to help ensure others are equipped to support mothers in their breastfeeding journeys. Women who gave birth by C-section are supported by the staff nurse or a family member to be able to correctly position the baby for a secure attachment.
According to India’s recent National Family Health Survey (NFHS 5), the neonatal mortality rate (deaths before the first 28 days) in Uttar Pradesh is 35.7per 1,000 live births. Although this rate has dropped from 45.1 where it was in the previous survey, there is still more work to be done. Institutional deliveries and deliveries by a skilled birth attendant have improved to over 80% of births, however, timely initiation of breastfeeding remains at only 23.9% of newborns being breastfed within one hour of birth. The survey also revealed an increase in C-section deliveries to 13.7%. Strengthening district hospitals to facilitate comprehensive training with lessons that can be brought back to community health facilities can play an important role to further reduce neonatal mortality.
The Centre of Excellence has hosted numerous training sessions for staff nurses and auxiliary nurse midwives, conducted by mentors from the Federation of Obstetrics and Gynaecological Societies of India and the Indian Academy of Paediatrics. The sessions are planned in accordance with the Government of India’s norms and standard operating protocols for maternal and newborn care. They build the knowledge and capabilities of nurses and auxiliary nurse midwives who directly support women and their families during pregnancy, childbirth and throughout the postpartum period. They focus on building a core understanding of complication management during delivery (such as post-partum haemorrhage and eclampsia), respectful maternity care practices, adequate record keeping, essential newborn practices and newborn complication management, including kangaroo mother care and timely initiation of breastfeeding.
Prior to training, Nutrition International conducted a pre-assessment of the district hospital to identify opportunities for improving service delivery in partnership with the government. The government undertook infrastructure developments and Nutrition International supported procuring equipment, setting it up in line with government protocols and improving the overall facility from a services perspective. A dedicated space for kangaroo mother care was also established. Once these were in place, training and mentoring sessions began.
“We are a team working to reduce maternal and neonatal mortality, and they, nurses and auxiliary nurse midwives, are our frontline soldiers.
—Dr. Shikha Sachan, Assistant Professor in the Department of Obstetrics and Gynaecology
Dr. Shikha Sachan, Assistant Professor in the Department of Obstetrics and Gynaecology at the Institute of Medical Sciences, Banaras Hindu University, Uttar Pradesh, facilitates training sessions at the centre and mentors health care providers like Sushila. “I am very happy to do so because these are the first soldiers in our fight against maternal mortality,” she shared. “We are a team working to reduce maternal and neonatal mortality, and they, nurses and auxiliary nurse midwives, are our frontline soldiers.”
Dr. Shikha said she’s noticed the interest and motivation of participants increase over the course of the sessions. “It’s encouraging to see how much these people want to learn and how much they want to do their jobs. When you provide instruction, demonstration, and tell them how they must follow these fundamental procedures, when they encounter dire circumstances, they use that knowledge and skill because they want to assist and save lives.”
By its very design, the Centre of Excellence serves as a knowledge institution demonstrating optimal standards of maternal and newborn care practices, while building the skills of service providers in the hospital and beyond. “We are able to improve maternal and newborn care with the assistance of mentorship sessions and technical support from Nutrition International,” said Dr. Urmila Singh, Chief Medical Superintendent at Pt. Kamalapti Tripathi District Hospital in Chandauli, Uttar Pradesh.
Nutrition International will continue to work with the Uttar Pradesh government to engage in strengthening health systems to deliver quality healthcare to people who need it most. Healthcare workers on the frontline, like Sushila, are a testament to the difference it makes.