This short mini-series focuses on sharing lessons learned from the programme Improving Quality of Maternal and Newborn health. This is a UK funded programme by the Foreign Commonwealth and Development Office (FCDO), and is led by the Liverpool School of Tropical Medicine.

In each of the episodes, we have been discussing different ways that the programme has strengthened the capacities of health practitioners to deliver high quality of care, to reduce maternal and newborn morbidity and mortality.

This episode is the third of four and is focused on improving the quality of midwifery education in Kenya, which has been historically under invested and has huge variations in terms of quality, content and duration.

Evidence has suggested that if universal health coverage of midwifery delivered interventions was achieved, we could save up to 4.5 million mothers and babies per year by 2035. We know that globally nurses and midwives are really the leading providers of assistance during childbirth, and so the quality of their education is absolutely vital for the survival of mothers and their babies.

About our guests:

Lucy Nyaga (Co-host) - Country Director, Liverpool School of Tropical Medicine, Kenya

Lucy is the Country Director, Liverpool School of Tropical medicine, in Kenya. She has a background in Medical Anthropology and Public Health with extensive experience in promoting implementation of research results into policy and practice with a special focus on maternal and neonatal health (MNH). With twenty years’ experience working in health programming, her experience and expertise in MNH has involved managing and implementing programmes that incorporate implementation research to inform effective programming and policy influence. Working with a range of organisations ranging from governments, academic and research institutions, UN agencies, and national & INGO, Lucy has led and contributed to key MNH research that has then led to policy influence in Eastern Africa.

Dr. Kelly Oluoch - KMTC Director, Kenya

Dr. Oluoch is experienced in training health professionals in the fields of pharmacy and strategic leadership and management of health systems. Rising from being a lecturer to head of department to principal of two campuses and he is now KMTC Director.

As part of making KMTC a recognisable brand globally, he is spearheading the search for foreign markets for its trainees with the initial cohort of 19 students having left for the UK in June this year.

He has a great interest in enabling a robust pharmaceutical regulatory framework and environment in Kenya.

Mr Benson Milimo - Midwifery Lecturer, Moi university, School of Nursing & Midwifery, Department of Midwifery & Gender

Benson has been involved in teaching, research and community service in midwifery education and works with the community and students every year for a period of six weeks to provide expertise to community health facilities, including midwifery services. Benson also guides students at undergraduate and postgraduate level to conduct research in midwifery and womens’ health.

Dr. Edna C. Tallam – Kimaiyo - Registrar and CEO, Nursing Council of Kenya

Edna Tallam is a global health champion and a national leader in transforming Kenya’s health systems, through the regulation of Nursing & Midwifery education and practice. Edna has been involved in the project in the spearheading review of the Nursing and Midwifery Syllabi, integrating emergency obstetrics and newborns care (EmONC), disseminating the syllabi and supporting capacity building of Midwifery lecturers and implementation research.

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Hello and welcome to our short mini-series focused on sharing lessons learned from the programme

This is a UK funded programme by the Foreign Commonwealth and Development Office (FCDO), and is

In each of the episodes, we have been discussing different ways that the programme has strengthened the capacities

This episode is the third of four and is focused on improving the quality of midwifery education in Kenya,

Evidence has suggested that if universal health coverage of midwifery delivered interventions was achieved, we could

We know that globally nurses and midwives are really the leading providers of assistance during childbirth,

We will be speaking with guests today to find out what is being done in Kenya to improve such education.

We have Dr.

Kelly Oluoch, who is the Chief Executive Officer of the Kenya Medical Training College, together with Benson

We also have with us Edna Tellum, who is the Chief Executive Officer at the Nursing College of Kenya.

So welcome to our guests.

We have the pleasure of having our co-host, Lucy Nyaga, who is going to help us through the questions and the learning from the programme.

She is the country director of the Liverpool School of Tropical Medicine in Kenya and is a medical anthropologist by background,

So Lucy, ideally, midwives and nurses, when they are educated to a very good level, can deliver 90% of reproductive, maternal,

However, I believe the training at the moment in some lower middle income countries, including Kenya, is suboptimal.

Why don't you tell us a little bit about why this is the case and what does this mean for mothers and children before we

Kim, thank you for that introduction.

The key reason why we did this intervention of enhancing the skills of midwifery is because current curriculum for lower and middle income

The educators that we targeted, we wanted to increase their confidence in terms of delivering clinical teaching

You need to have this continuous professional education so that we can keep improving the skills of midwives, nurses, and in fact doctors

So basically the programme that we implemented together with the National Ministry, the Nursing Council, the

That is broadly what we can do and is what we are going be talking about, the programme that we implemented.

Now, we'd like to hear from our guests; Edna Tallam, the Chief Executive Officer of Nursing Council of Kenya.

Edna, how did your institution address the gap of below shortage in training in midwifery through the programme that we implemented

Thank you so much and I'll say that it's great that the Nursing Council of Kenya participated in this project.

The council regulates both nursing education and practice and in that regards, they need to be able to monitor the competencies for the

So in regard to this project, the council of course, together with all the stakeholders, with a gap analysis, which had been

So the syllabus is a guidance for the training institution to ensure that they review their curriculum and enhance

The other issue again was in regards of ensuring, yes, we've reviewed the syllabus, but then we need to disseminate to

And this is where then we went ahead and, uh, worked with the training institutions to ensure that the lecturers who will be able

Thank you very much Edna for that so basically, the Nursing Council of Kenya supported the syllabus, uh, review

Kenya Medical Training College is, uh, the training arm of the Ministry of Health.

We have 72 campuses and, uh, we have over 54,000 students.

One of the major courses that is being conducted at Kenya Medical Training College is nursing.

The vision of the institution is to train competent health professionals and, uh, do consultancy and research.

There are various aspects and I will talk about development of curricula, training of lecturers, mentorship programmes,

The LSTM programme has enabled KMTC to update its curricular in nursing, midwifery, and clinical medicine in relation

We have had the benefit of having 40 of our campuses being equipped with emergency obstetrics and new newborn

Again, this training has been very key in terms of ensuring that 233 nursing midwifery and clinical medicine lecturers are trained and

This has also been done online and hence making it possible to all lecturers to access this kind of training.

This programme has been very key in terms of training and follow up mentoring of midwifery educators in the 20 KMTC

Now, the preliminary results of this study show improved knowledge and skills of tutors to teach

This programme has been very key in developing a blended midwifery educator CPD programme that is continuous professional

This is now ready for piloting in Kenya and if possible, in Nigeria.

Finally, KMTC is also mandated to research and so much research is being done.

KMTC has participated in implementation of research findings for sustainable impact.

Dr.

Olouch Tell us how, the interventions that you've done, could or have, contributed to improving the life of a mother and a child.

The role of this institution is to provide human resources for health, which is one of the key pillars

It has reduced maternal, newborn and child mortality because now our trained health workers who have come through this

So this programme has helped us to equip our health workers with skills, knowledge, and competencies

Benson, we come from a university setting, tell us how this has trained them and then how this has

Allow me to mention three things that the LSTM through this programme has contributed at university level.

It touches on three main areas, which is capacity building, curriculum support, and lastly about equipment.

First of all, we appreciate the gap that was identified by LSTM and that is whereby the skills were a bit inadequate

Within our training, we have been equipped as a lecturer to be able to support the students during training with EmONC skills and therefore,

Mostly, most institutions at university level have put these skills, in the fourth year.

That is just preceding graduation, therefore, we are sure of competent and skilled midwives who are getting into the field.

We also have the aspect of curriculum support, which is part of what I've just talked in terms of

Nursing Council of Kenya is our regulator in terms of training.

So once, uh, nursing council came up with a syllabus of midwifery, which incorporates, emergency and obstetric and

So as an institution, we picked up that syllabus and at the moment we included in the Bachelor of Science in nursing training.

The curriculum is in progress almost at advanced level, but we have some institutions, universities in Kenya, who have

This line of thought was highly driven by LSTM involvement encouraging the skills for midwives.

Some in universities in Kenya have now established a Master of Sciences in midwifery specifically, so that

I know MOI University has also has a master's curriculum specifically in midwifery which is advancing, and in that line

Lastly, to add is that the equipment support of the skills lab has also been highly facilitated by the LSTM and other

Thank you very much Benson.

For me, what I feel it was a programme that has had spiral effect in terms of, not just very focused on one aspect, but

I would like to then come back in terms of the best practice from these programmes.

What would you say are the best practices that we can take forward from implementing the programme on

The best practice that I have seen is the continuous assessment, the monitoring that, we have experienced with our partner.

We have also seen the provision of the equipment and the skills, so that has helped the skill transfer from the lecturers to the students.

We started with the training of the lecturers, which has been very good, and they're able to transfer the skills to the students.

And that has also translated to the good care of the patient wherever they have been.

So we've got a very good results and the information about how our students are doing.

So that's one thing, and also, I realised there was that cross monitoring of the lecturers.

The good interaction and communication that has been there has also been very good.

That is some that I wish any other person would carry forward whenever they are helping another institution.

Just a follow on quickly because I think eventually, when we train and you've given us, you know, a sentence that

Do you have some suggestions on how this can be truly, truly associated with the programme?

I think we could also kind do a survey or a research checking on where we have posted those people who have gone through

So now we can be able to tell have they been able to translate what they learned to the community.

The feedback would get from there I think would be very helpful if you could be able to follow them up to their working areas.

I also would, wish, I dunno whether it is also part of the, the project that the environment should also be very conducive because if

So the support also should go to the places where they're working.

What I hear you saying, you know, it's just not one, it's not one aspect.

We have to look at things wholesomely.

We could have very well trained midwives and nurses out there, but if the other health building blocks are not in

I think lobbying others stakeholders to also input so that the training translates into real life impact.

You see this, uh, project was a collaboration between the policymakers, Ministry of Health, the educators.

We've seen our two colleagues here, the regulators, and we have generated evidence-based researchers, which will be able to

Going forward and replicating is ensuring that we need to bring all the policy makers on the round table, design the project,

Also pride on the little lessons that we've done, the outcomes of the project and continuously monitor for the sustainability to achieve

Dr.

Olouch what would you say are the key best practices that other medical training institutions across lower and

The best practices that we have identified from this programme is number one; regular update of curricula.

That curricula should reflect the reality of practice that curricula should enable us to offer solutions to emerging issues in practice.

The second issue that I think is a best practice is the issue of training mentors.

Mentorship training is very key in practice so that, uh, as we continue offering services, we have mentors

The other issue that I can say is the best practice is continuous professional development, that all professionals

Finally, research.

That one of the best practices is to advance knowledge and develop knowledge that influences practice and influences policy.

Through this programme, we've been able to practice research, be able to generate knowledge, be able

Thank you so much.

Thank you, Dr.

Oluoch.

I would like to hand over back to Kim.

This has been a very interesting conversation and so much has been done in the programme.

Lucy, I would like to hear from you a little bit on how the programme has gone from your perspective and any advice that you would

From LSTM perspective, we actually have achieved more than we really actually imagined that we could achieve and have

This is very cost effective, time effective, and it'll be able to, uh, increase, uh, the number of competent midwives and nurses

So thank you very much to our colleagues that we've been able to work with.

I guess from where we are now, although the programme is coming to an end, what has been achieved is just for institutions to carry forward.

So it has been institutionalised and we are happy that this will go forward.

Thank you, Kim.

Thank you, Lucy.

I just have one final question for Edna.

Edna, one of the things we heard at the beginning of this episode is a need to increase the confidence

Is there any evidence that confidence is increased and that they feel better able to deliver quality services?

Yes, indeed.

Uh, we need to be able to increase confidence, and confidence comes once we are able to enhance their competence.

At the moment we are undertaking the monitoring and evaluation in the information of the curriculum and perhaps now as

There'll be confidence to ensure that they collaborate with the other clinicians, including obstetricians.

So this is an ongoing work but in regards of the confidence of the learners of, and also the confidence for the lecturers, yes,

That's great.

So it sounds like across all the programmes, there's been not just a focus on the technical aspect, but those soft

That's correct.

In regards of the overview of the syllabus, apart from the technical.

Note that we have the general competencies as prescribed by National Confederation of the Midwives,

It talks about the autonomy for the practice, the policies and that, that has still been enhanced within the syllabus, because it'll go

Benson, you're coming from a university perspective there, have you changed the mechanisms

We have actually improved, our approaches in teaching based on the outcomes of collaboration and this

So that is one of the greatest approach that has improved after this collaboration.

Thank you very much.

So, much more practical aspects there.

So it's great to hear.

Thank you so much for this conversation.

Thank you to Lucy, who's been a wonderful co-host and also to all of our guests for really sharing the immense amount of work