Exploring Nurses’ Perspective about Helping Babies Survive Programme in Western India – Qualitative Findings

Background: Helping Babies Survive (HBS) program was piloted in five districts of India during 2016-17. Landscape analysis evaluated changes between HBS and non-HBS healthcare facilities to understand how the program had influenced newborn care practitioners and practices.

Objective: To understand nurses’ perception towards usefulness of HBS trainings and experiential feedback for further strengthening HBS implementation and scale-up

Methods: Interview guideline was developed and perception explored through in-depth interviews. Total 14 nurses were interviewed (9 HBS trained, 5 untrained). Manual content analysis was done to report the findings under pre-defined thematic domains - Delivery and Newborn Care Practices; and HBS Skill Station/Practice Sessions/Continuous Quality Improvement(CQI).

Results: Nurses perceived that HBS training, CQI initiatives, visits by mentors and program officers(PO) helped in skill improvement. It helped improve birth preparedness, patient communication during labor, delivery per abdomen, skin to skin care(SSC) and early initiation of breastfeeding. HBS training also improved self-confidence to administer initial care, including resuscitation, to babies not crying/unstable who were earlier referred out without any interventions. Nurses learnt that not all babies require bag & mask or ventilation, and many a times baby responds to rubbing or stimulation.

Nurses were able to practice at designated HBS skill stations within their facilities, however organizing peer practice sessions were challenging. Shortage of staff, shift duty, staff attrition/rotation and workload were cited as primary reasons for inability to regularly practice. Visits by HBS POs were catalytic in facilitating peer practice sessions, discussing real life challenges and having shared insights and hence are of paramount importance to ensure CQI.

Conclusion: Nurses perceived that HBS training and mentoring visits helped deliver essential newborn care even at remote facilities. Further implementation and scale-up of HBS program should emphasize facility visits by HBS POs/mentors on monthly basis and strategies to address known facility-level barriers to CQI.