1a-introduction-to-enc-for-facilitators.pptx

Draft version for field testing
Essential Newborn Care Modular Course
Introduction for facilitators

Module 1 - Page 1
Essential Newborn Care Course
Second edition, interim version
1. Goal
2. The situation
3. Course overview
4. Methodologies
5. Facilitator competences
6. Quality Improvement
8. Reference materials
7. Summary
1. Goal and learning outcomes
Every newborn everywhere receives evidence-
based care.
⁃ Apply essential newborn care facilitation and adult
learning methodologies.
⁃ Build knowledge and competencies of learners to
provide evidence-based quality care to save lives,
prevent disabilities and ensure that every newborn
reaches their full potential.
⁃ Facilitate and mentor peers using essential
newborn care learning methodologies and
updated modules.

Module 1 - Page 2
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
2. The situation
• 2.5 million newborns, more than 2 million
stillbirths and 295 000 mothers die annually
around the time of childbirth.
• The highest neonatal mortality numbers and rates are
in humanitarian and fragile settings (45% of newborn
deaths) with 29 million babies born in humanitarian
settings 2018.
• The quality of essential newborn care can be
improved everywhere.

Module 1 - Page 3
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
2.1 Coverage falls off at every step
Adapted from Tanahashi T, 1978

Module 1 - Page 4
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
3. Target groups and delivery mode
• All health workers caring for newborns or who will
care for newborns
⁃ Multidisciplinary teams: midwives, nurses, doctors
and pre-service students
⁃ Facilitators, supervisors, coaches and mentors
• Learner levels
⁃ Foundation: Trained health workers with no
newborn care experience and pre-service students
⁃ Intermediate: Health workers updating their skills
and competencies (in-service)
• Delivery mode
⁃ Face-to-face
⁃ Blended learning (self-paced and face-to-face
learning)

Module 1 - Page 5
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
3.1 Apply WHO learning strategy
• Learning is active, not passive.
• Learning addresses real-life issues.
• The process of learning is as important
as the content.
• People learn with, and from, peers.
• People identify, plan and monitor their
own learning.
• People use different learning
strategies.
• Learners engage in reflection and self-
evaluation.
• Feedback is critical for change and
improvement.
@WHO

Module 1 - Page 6
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
3.2 Evidence-based health care
1. Evidence
generation
2. Evidence
synthesis
3. Evidence
transfer
4. Evidence
implementation
Facilitating evidence-based
practice in nursing and midwifery in
the WHO European Region
Benefits?
• Improve quality of care
• Better outcomes for women and newborns

Module 1 - Page 7
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
Lancet series midwifery
3.3 Framework for quality maternal and
newborn care

Module 1 - Page 8
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
3.4 WHO quality of care framework
Standards for improving quality of maternal and newborn care in health facilities - Page 16

Module 1 - Page 9
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
3.5 Universal rights of newborns

Module 1 - Page 10
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
3.6 WHO standards for newborn care
Standards for improving quality of
maternal and newborn care in health
facilities
Standards for improving quality of
care for small and sick newborns
care in health facilities

Module 1 - Page 11
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
3.7 Assessment
• Use assessments of learners
⁃ Pre-test to design sessions to meet learners’ needs
and guide learners’ journeys.
⁃ Post-test (summative) to document the progress of
learners and the quality of the training.
⁃ Self and peer assessments of performance
improvement during simulations and clinical
practices.
• Learners observe health workers, organization of care
and case management during clinical practice sessions
and assess if quality gaps exist.

Module 1 - Page 12
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
3.8 Delivery of Essential Newborn Care Course

Module 1 - Page 13
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
3.9 Basic course
• Action Plans
• Flipcharts
• Provider guides
• Simulation practice cards

Module 1 - Page 14
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
3.10 Modular course
14 modules:
• 3 cross-cutting themes
• 6 routine care
• 2 intermediate care
• 3 additional care

Module 1 - Page 15
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
3.11 Content and flow within modules
1. Goal and learning outcomes.
2. The situation.
3. Diagnostic simulation to assess starting point of
in-service learners.
4. Key steps demonstrated by facilitator, videos, case
studies and knowledge verification.
5. Simulations to apply new knowledge, decision-
making and improve performance in preparation for
clinical practice.
6. Treasure hunt to find WHO recommendations and
guidelines.
7. Mentored clinical practice with specific learning
objectives, and structured debriefing.
8. Point of care quality improvement exercise.
9. References and additional reading.
10.Learners continue practising with their peers.

Module 1 - Page 16
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4. Essential newborn care learning
methodologies
• Self-paced learning
• Critical reflection on practices
• Videos
• Questions/quizzes
• Case studies
• Demonstrations (mannequins and newborns)
• Simulations
• Role plays
• Mentored clinical practice
• Treasure hunts
• Point of care quality improvement (POCQI)
• Peer practice

Module 1 - Page 17
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.1 Symbols
Pre-service
In-service
Self-paced learning
Critical reflection
Videos
Questions/Quiz
Case study
Role play
Simulation
Clinical practice
Treasure hunt
The situation
Summary
Quality improvement

Module 1 - Page 18
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.2 Self-paced learning
• Learners complete sections on their own or with
peers either:
⁃ in advance as preparation for the module
⁃ for reinforcement after facilitated face-to-face
sessions
⁃ online (WHO Academy) as part of blended
learning
⁃ using linked applications (Apps)
⁃ facilitated during this face-to-face course.
• Self-paced learning includes questions, case
studies, videos and treasure hunts for guidelines
and recommendations.

Module 1 - Page 19
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.3 Critical reflection on newborn care
practices
What is critical reflection?
Throughout the course support learners to:
1.Identify personal strengths and areas for
improvement.
2.Seek input and support from peers or mentors.
3.Identify personal learning needs.
4.Develop solutions to meet learning needs.

Module 1 - Page 20
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.4 Videos
• All modules use videos.
• Some are optional for self or peer learning, as
preparation for or reinforcement of modules.
• Long videos specify start and end points.
Self-reflection or discussion questions after watching
video(s)
1.What is new knowledge for you in the video?
2.Are there any skills or practices that are different from your current
practice?
3.What provider behaviours are different from your current practice?
4.Does this video highlight a performance quality gap or problem in
your setting?

Module 1 - Page 21
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.5 Facilitate effective use of videos
• Explain the process and show the video.
Respectful care during labor and birth
• Facilitate a discussion ensuring reflection and
critical thinking.
• Promote discussion of effective communication
and respectful care of the newborn.
• Peers give constructive feedback to the facilitator.

Module 1 - Page 22
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.6 Questions/quizzes
• Questions cover evidence-based content.
• There are a number of formats (blended learning)
⁃ True/false
⁃ Multiple choice
⁃ Ordering
⁃ Ranking
⁃ Observation of correct and incorrect practices

Module 1 - Page 23
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.7 Facilitate questions/quizzes
• Select a slide with questions from ANY module,
ensuring that the question level is appropriate for
your learners (pre-service or in-service).
• Follow instructions.
• Explain answers if needed.
• Ensure that the session is interesting and fun.
• Keep up the pace and interest.
• Ask for feedback from your peers.

Module 1 - Page 24
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.8 Case study: introduction
• Case studies act as instructive examples for
learners of a particular newborn case, describing
the background of the newborn and clues that the
learner should pick up.
• Case studies generate an in-depth understanding
of an essential newborn care issue in its real-life
context.
• Learners answer questions and then integrate
evaluation, decision-making and actions using the
Action Plan and applying WHO guidelines.

Module 1 - Page 25
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.9 Case study: Process
• Review the case study.
• Organize small groups (4 learners).
• Ask learners to read, reflect and answer questions.
• Ensure that learners use the Action Plan or a job aid.
• Discuss answers and give feedback.
• Help the learners to summarize and explore how they
will apply new knowledge.

Module 1 - Page 26
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.10 Case study: Example Visnu
• Vishnu has just been born by spontaneous
vaginal delivery.
• He was 29 weeks gestation.
• He weighs 1200 g.
How will you manage Visnu safely?
Referring a small baby

Module 1 - Page 27
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.11 Case study: Facilitation
• Select a case study.
• Facilitate your group of 4.
• Debrief with your peers.

Module 1 - Page 28
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.12 Some definitions
What is a:
• Demonstration?
• Role play?
• Simulation?
• Case Study?
Demonstration
Role
play
Simulation
Case
study
Who
Facilitators and
learners
Learners Learners Learners
Scenario Not always ✓ ✓ ✓
Script ✘ ✓ ✘ ✘
Decision-
making and
actions
✓ Not
always
✓ ✓
Hands on,
real-life
situation,
equipment
✓ ✘ ✓ ✘

Module 1 - Page 29
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.13 Simulation: Introduction
• Simulation is a set of structured activities representing
actual situations, played by learners in a realistic
environment using real materials and equipment to
develop or build knowledge, skills and behaviours.
• Simulation is hands-on practice to promote or validate
the learners’ progression in a safe learning environment.
• A safe learning environment is a positive emotional
climate, created by facilitators who inspire trust and allow
mistakes and trial-and-error learning.
• A scenario is the description that provides the context
for the simulation: objectives, description of the
situation, actions expected from learners.

Module 1 - Page 30
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.14 Simulation: Process
• Every simulation has specific objective.
• Form groups of 4 (“mother”, “health worker”, “companion”
and observer).
• Brief (where taking place, equipment, time allowed, etc).
• Read scenario.
• Run simulation.
• Swap roles and rerun the simulation until all 4 members of
the group have practised.
• Facilitate a structured debrief, giving constructive
feedback from the group members and facilitator.
• Discuss and explore norms, behaviours or harmful
practices in a safe environment.

Module 1 - Page 31
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
• Form groups of 4 (“mother”, “health worker”, “companion”
and observer/helper).
• Use a newborn mannequin and any other equipment you
normally use.
1. Receive Aarush and carry out immediate newborn
care.
2. What do you do next?
• Participate in the debriefing.
• Continue to practise with your peers.
4.15 Simulation: Meena gives birth
• Meena gives birth to her son Aarush by normal vaginal
delivery at term.
• There are no complications.
• Aarush breathes and cries.

Module 1 - Page 32
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.16 Simulation: Facilitation
• Select a simulation from any module.
• Follow instructions.
• Brief.
• Run simulation.
• Debrief.
• In plenary discuss effective running of
simulations.

Module 1 - Page 33
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.17 Role play: Introduction
• Role play is acting out of the part of a particular
person or character as a technique in training.
• The aim is to give a good performance or
imitation. Emotions, personalities and ethical
motives are supplied in the script.

Module 1 - Page 34
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.18 Role play: Process
• Read instructions.
• Share the script with learners the day before the
session.
• Brief participants, explaining objectives and roles.
• Facilitate the role play.
• Debrief.
• Discuss and reflect.

Module 1 - Page 35
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.19 Role play: Facilitation
• Choose a role play from the communication
module.
• Read instructions.
• Share with the learners playing roles the day
before the session, explaining objectives, roles
and the environment.
• Brief participants, explaining objectives and what
is expected of them.
• Facilitate the role play.
• Debrief.
• Discuss and reflect.

Module 1 - Page 36
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.20 Clinical practice: Introduction
• Clinical practice is an essential activity of this
course to build neonatal care competencies.
• Each module has a clinical card to facilitate learning.
• Learners should:
⁃ Complete the feedback sheet for constructive feedback
for their team
⁃ Reflect on and document quality gaps
⁃ Continue to practise with their peers.

Module 1 - Page 37
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.21 Clinical practice: Process
• Review the methodologies.
• Organize your group.
• Select and review the appropriate clinical practice card.
• Discuss how to organize and facilitate in your context.

Module 1 - Page 38
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.22 Clinical practice: Facilitation
Assigned facilitator/s to run the clinical practice
• Organize the group.
• Brief.
• Run session.
• Debrief.
• Discuss in plenary.

Module 1 - Page 39
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.23 Treasure hunt: Introduction
• Treasure hunt is an activity enabling learners to
find and apply evidence from the latest WHO
recommendations/guidelines/documents.
• Run it as a game or competition. It should be fun.

Module 1 - Page 40
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.24 Treasure hunt: Process
• Read the guiding question.
• Learners search for the treasure in
recommendations/guidelines/documents.
• The first learner or team to find the treasure
shares their findings.
• Ask another learner to explain the treasure and
why it is important.
• Confirm the findings, facilitate a discussion on
how to systematically apply the recommendation.

Module 1 - Page 41
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.25 Treasure hunt:
Example breastfeeding and COVID-19
• Do we recommend skin-to-skin contact and early
initiation of breastfeeding during the COVID-19
pandemic?
• Find the guidance on pages 55–56.

Module 1 - Page 42
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.26 Recommendation and reasons
• Mothers with suspected or confirmed COVID-19
should be encouraged to initiate and continue
breastfeeding.
• Benefits outweigh harms
⁃ Breastfeeding and skin-to-skin contact protects against
childhood illness and death, especially against
infectious diseases.
⁃ Children who are not breastfed are at higher risk from
infectious diseases and lifelong ill-health from some
non-communicable diseases.
⁃ Deaths of infants separated from mothers and not
breastfeeding would be at least 60 times greater than
possible deaths due to COVID-19.
Review the evidence
Clinical management of COVID WHO 2021

Module 1 - Page 43
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
4.27 Treasure hunt: Facilitation
• Review the methodologies.
• Choose a treasure hunt from any of the modules.
• Facilitate following instructions in the module you
have chosen.

Module 1 - Page 44
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
5. Facilitator competencies
• Master all the content of the ENCC.
• Apply adult facilitation and learning methodologies to
promote active learning.
• Adapt and tailor facilitation according to learners’
needs and based on standardized assessments.
• Support learners to apply evaluation, decision-making,
action cycles.
• Promote skills practice for clinical scenarios and
simulations using correct technique, facilitating self
reflection and peer feedback.
• Use clinical practice effectively.
• Understand and apply the Point of Care Quality
Improvement Process (POCQI).

Module 1 - Page 45
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
6. Quality of care: Why is it critical?
• Poor quality of care contributes to mortality and
avoidable disability.
• Many newborns do not receive appropriate,
evidence-based care. Country equity profiles: Countdown 2030
The interdisciplinary newborn care team
must contribute to improving quality of
care to save lives, prevent disabilities and
ensure that newborns reach their full
potential

Module 1 - Page 46
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
6.1 POCQI is a tool – a model to improve
quality of care at the point of care
• Improve clinical (health) care and longer term
outcomes for newborns.
• Improve experience of care: respect, protection
and fulfilment of newborn rights and preservation
of dignity, zero separation, birth registration.
• Improve safety: reduce harm.
• Optimize cost: reduce wastage.
POCQI depends on:
• Health care teams’, mother’s and family’s engagement.
• Availability of essential infrastructure and supplies.
• Support of the local leaders and local system.
• National and subnational system support.

Module 1 - Page 47
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
6.2 Four simple steps: Cyclical process
1. Form a team and identify a quality gap (problem).
2. Perform root cause analysis: Understand the causes of the
problem.
3. Identify solutions (change idea): Develop and test a change:
⁃ Implement the solution
⁃ Use local data to check for improvement
⁃ Failure: Apply alternate change idea
⁃ Success: Continue the changed way
4. Sustain the improvement
Plan
Do
Study
Act
Improving the quality of care for mothers, newborns and children
in health facilities: facilitator manual. Version 3 (who.int)
https://www.pocqi.org/ and https://www.nqocn.org/

Module 1 - Page 48
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
6.3 Quality improvement in ENCC
NOT a POCQI training
⁃ Links to the process if countries and health facilities
are already implementing quality improvement
activities.
Pre-service learners
⁃ Document gaps or practices observed that need to
change.
⁃ Reflect on practical solutions.
⁃ Discuss and prioritize one simple, achievable step.
In-service learners
⁃ If trained in POCQI, link to the full Plan-Do-Study-
Act cycle.
⁃ If not trained, document gaps, prioritize and
discuss as above.

Module 1 - Page 49
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
6.4 Example of POCQI for essential
newborn care in Myanmar
POCQI process Myanmar essential newborn care 4:02–13:43
The problem: Newborns NOT receiving
essential newborn care.
AIM: 80% of newborns receive essential care at birth.
1. Immediate drying
2. Skin-to-skin contact
3. Delayed cord clamping
4. Early initiation of breastfeeding
Dr R Mehta WHO SEARO

Module 1 - Page 50
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
6.5 Quality improvement in humanitarian,
conflict and vulnerable settings
• Ensure access and basic infrastructure for quality.
• Reduce avoidable harm.
• Improve quality of care.
• Engage and empower mothers, families and
communities.

Module 1 - Page 51
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
1
6.6 Facilitate a quality improvement session
• Observation by learners during clinical practice session
were:
2
3
4
5
6
All photographs @WHO/Dr Helenlouise Taylor

Module 1 - Page 52
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
7. Summary
• In this module, you have:
⁃ Had an overview of the WHO Essential Newborn Care
Course, edition 2.
⁃ Demonstrated how to facilitate using different learning
methodologies.
• You will apply learning methodologies when facilitating
the course.
• Continue to practise with your peers to build your
confidence and facilitation competencies.

Module 1 - Page 53
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
7.1 Next steps
• Over the next days you will facilitate assigned
module/s in pairs.
• Check the modules and sessions assigned to you
and your partner.
• Work together to prepare.
• Ask for advice when needed.
• Questions?

Module 1 - Page 54
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
8. Resources

Module 1 - Page 55
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
8.1 Resources
Global Health Media videos on website or
App Birth & Beyond
All India Institute of Medical Sciences, WHO
collaborating center website and Apps
Patient Safety: Safe maternal and newborn care

Module 1 - Page 56
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
8.2 Job aids: Action Plans
Action Plans help you to evaluate the situation, decide
what to do next and then carry out the evidence-based
steps whenever caring for a newborn.

Module 1 - Page 57
1. Goal
2. The situation
3. Course overview
4. Methodologies
7. Summary
8.3 Job aids: algorithms and checklists

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