Critical days after birth: neonatal resuscitation saves hundreds of babies in Vietnam

Practising neonatal resuscitation

In Vietnam, two thirds of all infants’ deaths occur within the first 28 days after birth. To lower this rate, the Ministry of Health and German Development Cooperation partnered to establish five Continuous Medical Education centers that now provide tailor-made training courses, including in neonatal resuscitation, for doctors, nurses and hospital technicians.

“Một và hai và ba và bốn và năm …” – the calm and rhythmic voice is familiar to all participants at the training session at Nghia Lo Regional Hospital in Yen Bai. Bent over neonatal resuscitation models looking like baby dolls, they practise in teams how to resuscitate newborn babies in case of an emergency. The training session is part of a Continuous Medical Education (CME) course initiated by the Vietnamese Ministry of Health (MoH) and Gesellschaft für Internationale Zusammenarbeit (GIZ). Based on the ministry’s 5-year plan and a government circular outlining regulations for continuous medical education, the GIZ health project Strengthening Provincial Health Systems has been supporting national efforts to improve the skills and knowledge of health staff.

Time to reduce infant deaths

One target of Sustainable Development Goal Number 3 is to end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and infant mortality to at least as low as 23 per 1,000 live births by 2030. What is the situation in Vietnam? In 2015, out of 1,000 Vietnamese infants 17 died before the age of one (World Bank, 2017). Of those, on average more than two thirds died within the first 28 days of their lives. However, infant and neonatal mortality is estimated to be higher in rural areas. Due to the remoteness of some regions, a lack of incentives for adequately trained personnel leads to serious staff shortages. Along with insufficiently equipped health facilities and other sources of difficulties as for example language barriers due to the variety of ethnic minorities in Vietnam and poor infrastructure, this leads to significant disparities between rural and urban areas. Although compared to previous years national figures on average declined, the number of deaths is still of great concern as many of them could be prevented. According to the World Health Organization (WHO) around two thirds of the worldwide newborn deaths can be prevented if health personnel are available and trained to provide respective health services (WHO, 2016).

Continuous Medical Education for better health services

In order to reduce the neonatal mortality rate health personnel must be enabled to diagnose and treat newborns and their mothers immediately and effectively. In 2013 the Vietnamese MoH reacted to the general need of continuous learning in all medical fields and developed a circular which regulates the management and organization of continuous medical education in the health sector (Ministry of Health, 2013). It stipulates that health workers have to participate in CME trainings regularly and in case they do not, their professional license would be revoked. The circular also sets standards for the accreditation of CME training centers regarding expertise, personnel and infrastructure.

The legal requirements and the personal motivation of health workers to increase their own skills and knowledge ensure that health personnel are motivated and willing to participate in CME trainings.

Five provinces, five new training centers

From 2009 to March 2017, the project worked in five of the most disadvantaged provinces of Vietnam (Yen Bai, Nghe An, Thai Binh, Thanh Hoa and Phu Yen) and established one CME training center in each one of them. The training centers were set up within existing hospitals, research institutions and medical and educational facilities.

According to the national regulations for CME, as defined in Circular 22, the following steps have to be followed to become a certified CME institution: first, the directors of the provincial health departments (DoH) have to approve the program including all learning materials. Then the heads of the health facilities have to approve the program and learning materials. The last entity to approve the program is the Department for Science Technology and Training of the MoH. They finally have to ensure that objectives, target groups, a detailed program, teaching and learning methods and training assessments are defined and included. If all authorities approve, the institution becomes a certified CME training facility. Successful participants will be awarded certificates by the respective DoH.

All of the training facilities approved so far have developed individual courses that meet the specific needs of the participants in that province. Contents range from updating knowledge, skills and attitudes in specific aspects of neonatal resuscitation to learning and applying new techniques. Irrespective of the content, the first half of each course usually covers theoretical contents; the second half applies the learned theory and focuses on practical skills.

Neonatal Models for practical training

Practising neonatal resuscitation

During the training courses the participants are trained by experienced doctors and nurses on the theory and practice of neonatal resuscitation. Especially practicing the necessary steps for successful cardiopulmonary resuscitation (CPR) is crucial. As this cannot be trained on real babies, using realistic models is vital. However, the costs for these models, which have to look and react like real babies, are very high. Before the joint project came to fruition, only few models were available in the training centers. This resulted in large groups of trainees having to practice on just one model giving each of them only few and short practice opportunities.

The project’s provision of additional models now allows for smaller groups and thereby increases the individual trainees’ practice opportunities. As neonatal care requires the expertise and support from experienced obstetricians and pediatricians, their collaboration is important and therefore strengthened in the course of the trainings.

More than 250 trainings in 2016 – and more to come

More than 250 nurses, technicians and doctors working in obstetric and pediatric departments of hospitals and health centers were trained in 2016. Equipped with this experience, CME training centers will continue to create and offer new trainings. Because trainings are designed in a cost-effective way and in line with the five-year plan by the MoH, it can be expected that the intervention’s results will be sustained and further improved in the future.

In Vietnam’s CME training centers, the familiar sound of “Một và hai và ba và bốn và năm…” – the rhythm of life! - will continue to be heard. Meaning “one and two and three and four and five….” it sets the pulse for the trainees who learn and practice to provide heart massage, a skill that is sure to save many future newborns’ lives.

Isabelle Weichsler, März 2017

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