Building sustainable local training capacity in maternal and newborn health within the public system- A training intervention research in Palghar District, western Maharashtra, India

IntroductionConstant investment for professional development of health workforce is paramount and can be implemented through locally available competent trainers. However, guidelines for selection and recruitment of trainers, and for approaches and processes of training and nurturing them are lacking. A training intervention research in western Maharashtra, India focusing on maternal and newborn health (MNH) attempted to address these gaps. MethodsDuring the pilot project in Pune District (2016-19), 38 health workers were trained as trainers in MNH with support from the United Kingdom (UK) based technical partners (obstetricians and pediatrician). From these, eight were selected and further trained to become core trainers (CTs) for MNH training during scale-up phase in Palghar District (2019-22). A local cadre of skilled master trainers (MTs) in Palghar (n=32) was developed by these CTs with support from the UK team, through a six-steps approach starting with pre-training of trainers (TOT) screening, TOT with pre- and post-training assessment, staggered induction of MTs, continuous support, regular quality assessment, and virtual refresher training. A mixed-methods approach was adopted to assess the process and outcome of this six-step approach. ResultsThe six-steps approach of developing Palghar MTs helped in optimal resource utilization during TOT. It allowed more time and non-threatening support to MTs to excel through peer learning. Pune CTs became competent and confident mentors through critical feedback and appreciation and provided long term support to the newly trained Palghar MTs. Regular assessment by the UK team was an essential quality control step. The virtual learning served as an effective mode for refresher training without interruptions during COVID-19. Considerable improvement in clinical knowledge and skills of the trainee health providers from Palghar (n=505) was evidence of quality training delivered by the Palghar MTs. The training intervention contributed to increased clinical competency, confidence, recognition, motivation, and contribution to career growth of the Palghar MTs. DiscussionThe TOT model used in Palghar demonstrated the importance of recruiting right candidates with essential attributes as trainers, conscious shift in their teaching style for making them adult-learner-centric facilitators, longer time frames and hybrid platform. A methodical approach for nurturing talent of trainers through opportunities for teaching as well as learning was highlighted. However, a systematic evaluation for assessing long term effects of this model on retention of clinical and teaching competencies of these trainers and their trainees and its application in provision of MNH care is required.