P0263 - Improving quality of intrapartum care in Zambia by expanding on Helping Babies Survive (HBS) and Helping Mothers Survive (HMS) training using Project ECHO (Extension for Community Healthcare Outcomes)

Background: Zambia continues to face a high burden of maternal and newborn mortality, with an estimated 1,400 maternal deaths and 13,000 newborn deaths occurring every year. Inadequate number of skilled birth attendants and infrastructure and service gaps are key barriers to advancing progress. HBS and HMS are evidence-based curricula shown to reduce neonatal mortality rates (NMR) and maternal mortality rates (MMR) in low-resource settings. The ECHO model offers an opportunity to improve intrapartum care in Zambia by expanding on previous HBS and HMS training using an innovative tele-mentoring approach.

Objective: Building on previous HBS and HMS training in Zambia, design, implement, and sustain an ECHO tele-mentoring project to increase the capacity of midwives to provide quality intrapartum care across the 10 Zambian provinces.

Design/

Methods: Project ECHO is a tele-mentoring program designed to create communities of learners by bringing together health care providers and experts in topical areas using didactic and case‐based presentations, fostering an "all teach, all learn" approach. The Midwives Association of Zambia (MAZ) serves as the ECHO hub and connects with ‘spoke’ providers in the 10 Zambian provinces via Zoom videoconference technology. In April 2019, the American Academy of Pediatrics (AAP) facilitated a three-day ECHO immersion training in Lusaka with MAZ and a multidisciplinary faculty team comprised of midwives, an obstetrician, a neonatologist, HMS/HBS master trainers and Ministry of Health (MOH) officers. During this training, the faculty team helped design the ECHO curriculum based on the HBS/HMS curricula and local needs. MAZ recruited ‘spoke’ participants and procured and provided iPads and technical assistance for faculty and spokes. The Zambia Intrapartum ECHO sessions occur twice monthly over 12-months and include case presentations, demonstrations and discussions. Program evaluation will assess increased knowledge and confidence among intrapartum care providers.

Results: Experiential sharing of case management for preventable intrapartum and postpartum complications resulted in increased number of providers interested in joining the sessions (Table 1). Participation continues to increase as more providers download Zoom on their phones. Midwifery student attendees are enhancing their knowledge and skills, as reported by their lecturers. The MOH recognized the ECHO project and senior officers join the sessions. Midwives across the provinces are submitting topics and actively requesting more case studies and specific skills demonstrations. MAZ has experienced an increase in membership that is attributable to this project. See Table 2 for an overview of qualitative feedback.

Conclusion: Initial feedback indicates that Project ECHO is a feasible, affordable and effective model for building upon prior HBS/HMS education, assuring high-fidelity training, maintaining and increasing skills and competencies around care of the mother and baby at birth, and facilitating a collaborative learning environment for providers across Zambia.