Impact of Manyata Flagship Program on Effective Management of Maternal Complications - Task-Shifting to Staff Nurses with Improved Competence

BACKGROUND Postpartum haemorrhage (PPH) and pre-eclampsia and eclampsia (PE/E) are the leading causes of pregnancy and childbirth-related complications and deaths, particularly in developing countries. FOGSI-Manyata skill transfer training is being implemented in private healthcare facilities in India, enabling ‘task-shifting’ to staff nurses by improving their knowledge and skills towards achieving desired maternal and perinatal outcomes. METHODS In this qualitative study, 4 focus group discussions (FGDs) with staff nurses and 14 in-depth interviews (IDIs) with head consultants of study facilities and assessors from different states (both metro and non-metro regions) were undertaken. Their experiences and perceptions about Manyata training, including its impact on building their capacity towards efficient handling of maternal complications during childbirth, were explored and the data was analysed through thematic analysis. RESULTS The two main overarching themes included: barriers to prevention, early identification and handling of complications, and post-training competency gained for effective management of complications. Lack of skilled staff trained in obstetrics and gynaecology, gaps in basic knowledge and skills in emergency obstetric care (EmOC), limited training opportunities at the workplace, and high staff turnover were identified as the factors contributing to the perceived importance of the training program. The competencies gained by staff nurses through Manyata training included readiness for prevention and early detection of complications (PPH and PE/E), improved understanding of specific causes of PPH, preparedness for timely management of both PPH and PE/E, and coordinated teamwork. CONCLUSIONS All the respondents strongly valued the Manyata training for effective management of maternal complications, PPH, and PE/E. Such in-service training, which is also appropriately tailored to the local context, along with the strong motivation of head consultants and staff nurses to upgrade themselves through continuous efforts, is required to achieve sustainable goals to reduce maternal and perinatal mortality.