ETATMBA PROJECT EVALUATION
Qualitative Baseline Report(Narrative)
1. Introduction
This paper reports on the main findings of the interviews that were conducted with ETATMBA
trainee during baseline. The interviews were conducted in the 8 intervention districts which
include Ntcheu, Lilongwe, Nkhotakota, Kasungu, Mzimba, Rumphi, Karonga and Chitipa. A
total of 21 trainees were interviewed. Initially it was planned that apart from the ETATMBA
trainees, other service providers in the intervention districts who have received training from the
ETATMBA trainees and district health officers, medical officers or nursing officers were to be
interviewed as well, however because at the point when the first interviews were conducted not
much had been done and therefore it was decided that only the trainees would be interviewed. It
is expected that during the first follow up interviews will be done with trainees, those who have
received the cascaded training, the district health officers, or the district medical officers and the
district nursing officers in the intervention districts.
All the interviews were done in English and were recorded using a digital recorder. The
interviews mainly captured trainees’ perceptions and opinions about the training that they are
going through. This included the trainees’ impression of the training, their expectations about the
training, and how the training has benefited them. In addition participants were also asked about
how they have carried various assignments that they had been given, how they been able to
implement what they learnt in training and the challenges that they have faced.
The interviews were later on transcribed and the transcripts were imported into NVIVO 8
software for analysis. The theoretical framework for analysis was divided into main themes
according to the main questions in the interview guide. Some of the main the themes were
further split into subthemes. All the responses pertaining to the themes were put into the theme
categories and later on read and analyzed individually according to theme.
2. Results
2.1 Impression of the Training
Almost all participants were positively impressed with the training and indicated that it is one of
the best ways of reducing maternal and neonatal mortality in Malawi. When participants were
asked to compare the training with previous trainings including their pre-service training,
participants reported satisfaction with the ETATMBA training because of use of practical models
to demonstrate how to deal with different cases they meet unlike previous trainings which mostly
centered on theory. The participants also indicated that whilst their pre-service training focused
on so many things in their profession, the ETATMBA training mainly focused on the things and
cases they meet in their everyday practice and how to deal with such. In addition participants
were also highly satisfied with the caliber of tutors facilitating the ETATMBA training of which
they indicated to be both experienced and experts in the field of obstetrics and neonatal care.
“Yes in a pre-service training usually the major differences I would say is, we were, we usually, I
mean so much burnt on theoretical approach to things while in this training all the modules were
actually very practical helping the baby breath, you actually have a doll to demonstrate on and it
was very reflective such that after coming from the training to apply what we learnt it was not as
difficult as we should have had experienced if it was theoretical approach to things”[CA-002]
Most of the participants also reported to have been satisfied with the course materials that were
given to be used during the training which included the books, dongles and the baby model
neonatalia. All participants indicated how helpful the baby model neonatalia has been in
improving their skills in management of neonatal cases. In addition it was also reported that
some materials like the live saving book are being used continually even after the training as a
point of reference when they meet some cases.
“The course materials they gave us they were very helpful and especially they gave us the
dummy which we were using for resuscitation of neonates, it is also helping us much and we are
trying to train nurses especially on the resuscitation of the new born.”[LL-002]
When the participants were asked to mention what they remember most from the first
ETATMBA training most of them indicated that they remembered most the practical sessions.
The demonstration of neonatal resuscitation with the use of baby model neonatalia was
mentioned as the most captivating by almost all participants. In addition practical sessions on
management of Post partum hemorrhage and eclampsia were also mentioned frequently as
unforgettable by most participants.
“Most two things I remember currently very much is the resuscitation of a newborn who is
failing to breath and the management of PPH these are major two things I can remember now
and again”[KK-002]
Participants also indicated appreciation of the ETATMBA training in that through this training
they have acquired some new skills in their profession. For instance participants indicated that
through this training they have learnt the new ways of managing cases e.g. B-lynch suture in
PPH. In addition participants also indicated that conducting the audits was a skill which they
have learnt during the ETATMBA training. Further the participants reported that the practice of
writing cases they encounter in logbooks was a new skill which they have benefitted from the
ETATMBA training. Participants also indicated that the ETATMBA training has been an eye
opener to most of the things that they were doing blindly in their practice.
“Yes, management of the PPH the approach to the management of PPH, there are number of
things that we were being doing previously but when I went there it was an eye opener on some
of the things, we were discussing things that we were maybe doing them without knowing why
we are we doing them, so like the use of sytotec and the use of pitosin to control PPH we
thought that sytotec had more impact in controlling PPH than Pitosin but during the lectures it
was noted that pitosin is much more better than misoprostol and also we learnt about the BLynch Suture which is new to me in controlling PPH but when it was explained and we tried on
the models, it really feels as if it can perform wonders”[LL-005]
“New discoveries, its where we have been looking at when we are resuscitating a new born
always we gave up very easily because people were saying a new born who cannot breath after
ten minutes then that one will be useless, but we have found that given time and given good
extra time you find that, that could be done so I think from that time I have learnt that given time
and at least improve knowledge on how to resuscitate a new born can make a difference to the
life of the baby yes.”[LL-002]
2.2 Training Logistics
They were varying comments when participants were asked to give their views on the training
logistics in terms of transport, accommodation and food. Almost all participants did not have any
problems with food that was provided during the training period. However most of the
participants were not satisfied with the accommodation and transport arrangements.
On transport arrangement for participants who travelled from afar like Mzimba and Chitipa
districts were not happy with the amount of money that was given as a reimbursement indicating
that the money was by far not enough to cover the money they had paid for their transport to and
from where they had come from. In addition there were some participants who indicated that
they had not been reimbursed their money during the training and this was indicated as an
inconvenience to them.
Participants also showed dissatisfaction on the accommodation arrangements. They reported that
the lodges that they were accommodated in were of substandard especially those of Logic Inn in
Lilongwe. Participants indicated that at this lodge the rooms were tiny and poorly ventilated
which made it very difficult and uncomfortable for them. In addition the frequent power cuts in
the lodge made it impossible for them to read at night.
“Because the rooms were too small and it was that time very hot of course in terms of food it was
a bit ok but in terms of transports we had we had problems especially on the times we were
supposed to go back home because we were not reimbursed the transport in time and the when
my memory saves me right, the money we received was taken from the pocket of Mr, Dr Paul
O’Hare, I think Professor Paul O’Hare, is it Dr Paul O’Hare we were paid from his own pocket
so we were trying to wonder what kind of arrangements we have been here for almost five days
until the last day so you should be telling us we are not yet finalized processing your
money”[MZ-001]
2.3Communication with Tutors
Most of the participants indicated to have had a contact at least once with their tutors. The
international tutors were reported to be more active than the local tutors in terms of responding to
emails and giving feedback. The participants who have had communicated less with their tutors
indicated that access to internet was their main problem. They reported that despite being given
dongles most of them did not have laptops hence they could not use the dongles.
2.4Progress on Assignments or Take home Tasks
The participants reported to have been given three main tasks to do in their respective districts
which are filling of logbooks, conducting the audit, and cascading the training to their colleagues
in their work places.
a) Filling of Logbooks
Most participants indicated to have made little progress as far as filling of logbooks was
concerned. It was reported that this was as such because initially they were no clear instructions
given on how to fill the logbooks as such this created confusion. However the participants
indicated that latter on proper guidelines on how to fill the logbooks were given and there are no
further problems in filling of logbooks.
b) Conducting Audits
All participants reported that each one of them was given a task to choose an topic in their area
of work in which they can conduct an Audit. During the time of the interviews most of the
participants indicated to have submitted audit proposals to their supervisors and were waiting for
feedback. Other participants had already received feedback and were working on their audits.
c) Cascading of the Training to others
When participants were asked how the task of cascading the training to others was going on, it
was found out that there were some participants who had managed to do the cascading of the
training while other participants did not. There were several ways of doing the cascading
reported by participants who managed to do the cascading. Some participants reported that they
took advantage of the morning handover meetings in their facilities to present a topic or during
the continuing profession developments (CPD) meetings, where as some participants reported
that they would do mentoring whereby they would call nurses and other service providers to
watch whilst they are handling and managing a case and during that time they would teach and
transfer a skill.
“Everyday in the morning we have a morning meeting so most of the times am on call most of
the time yes so in the morning we discuss the cases we operated on, we discusses about the
outcomes every Tuesday no every Wednesday we reveal the partographs we do random selection
of the partograph in the maternity then we go through it and see how it has been filled and we
score out of 100 then we see the short falls and we make some kind of enhancement” [LL-005] .
They were also some participants who reported to have done cascading in health centers away
from their facilities however they indicated this was not easy because in such cases they had to
provide their own transport and lunch allowances. Participants reported that it was important to
cascade the training to service providers in health centers because most complications are
referred from the health centers however travelling to health center was always a challenge as
this was not provided for. Transport problem was also the main reason given by those who did
not do any cascading at all.
“Whilst it is not easy ,it’s a bit difficult, at our facility its easier but away from the facility it’s a
bit difficult that is at the health centers at first when we are just arrived we are given facilities
where we will be teaching our colleagues some of the things like resuscitation of the new born ,
breach deliveries but it was a bit difficult because frankly speaking I have just visited once my
health centers because of the challenge of fuel and transportation problems that is so I just
visited once and that time that we visited it I just collected data for the situation analysis so its
like I did not have enough time teach my colleagues” [KU-003]
d) Challenges faced to complete the Tasks
The main challenges reported by participants to complete their tasks were mainly in the task of
cascading the training and in conducting the audits. The most common challenge reported by the
participants was transport problem especially for those participants who had been instructed to
do the cascading or auditing outside their facilities. It was reported that most health centers
assigned to them were far and hard to reach. It was indicated that even in cases where they would
take advantage of an ambulance which was going to a particular health centre it did not work for
them because most of the times the ambulance would go to a health center to pick up a patient
and that means it would not be long at the health center and that meant the participant would
have to find own means of travelling back to their work place
“Okay, traveling from place to place we needed some money and in most cases we relied on the
ambulance going to such places now they can just damp you there, the ambulance is gone back
and you stuck there maybe for several hours and find your own means of transport”[KK-002]
Some participants reported that it was not easy for them to do the cascading of the training to
other service providers in their facilities because of staff shortages and workload.
“Time yes, secondly the targeted people, there is shortage of staff in our labour ward or in our
maternity wards so you find them always busy so for them to leave patients and have time to
listen to what you have to say it becomes a bit difficult so it’s like you can be prepared to deliver
to them but they have time to attend to patients only”[KU-004]
Another challenge that was reported was lack of support in terms of stationery which the
participants needed to use to collect data such as paper and pens.
“however on the same its like more less like the, we had to face challenges when like doing our
audits and the part of stationary itself because it’s like we had no plain papers of course we had
no pens or pencils and the like just to assist us to audit”[MZ-001]
Participants also indicated that it was also a challenge to leave their work places to conduct
audits somewhere else because they were also required to work at their work places.
“I was assigned to two health centers one of it is around 70km from here, the other one we are
talking of 100 something km from here, so the fact that we are also having problems with human
resources it means when I move away from my facility everything has stopped so instead of
concentrating on the things in my facility I go and do other things and most of the times we
ended up jobs being incomplete…” [LL-005]
“Even for me to find a day to be exempted from this institution to go to a health centre it’s a
bit difficult because time is not allowing because of the job am supposed to do here, it is all
coming because of the shortage of staff.”[KU-004]
Almost all participants reported of a challenge in terms of communication with their personal
tutors. It was reported that access to the internet was a major challenge for most of the trainees.
“here are issues of communication I need to talk to those people, issues of communication with
my personal tutor in UK, my personal tutor in Malawi I need to use a laptop, I need to have
airtime, so the main challenge on the issue laptop because for you to be on line you need to have
a laptop but you find sometimes one week you have not opened the email you find a lot of
important information because you take your dongle you find somewhere where the computer to
put it if out of the place for example you are not here at the hospital sometimes it is difficult to
access email, so if may be you have laptop which can be used anytime plus issue of airtime so we
need to have airtime may be from the project from the research its either research should
provide laptops, airtime for dongle so that you communicate with your tutors sometimes you
have an issue but you cannot communicate because of the issue of airtime” [LL-001]
Some participants also faced resistance from fellow service providers. It was reported that in
some facilities other service providers expected to get financial incentives in return after
receiving the cascaded training.
“That we had problems because these colleagues they thought we will give them something after
training them now most of the training was done on job when they call you, when he stuck
somewhere you teach him here and there most people expected to get something from us “ [KK002]
3. Training Concerns from Trainees
There were several concerns that were expressed by participants. The first major concern that
was reported by almost every participant was the uncertainty about which qualification they were
to obtain after completing the ETATMBA training. Participants reported that they had mixed up
information about what they will get in the end. It was reported that they had information that
they would have a Bachelors degree by the College of Medicine and also information that they
would have an Advanced Diploma by Warrick University. Participants indicated that this was
making them lose their motivation as most of them are interested in a Bachelors degree as a
career progression.
“But again I would actually look at the other driving force behind any other training is your
clear destiny to say am training in this program by the end of the day I will get this paper that is
very straight forward and specific while in this course that we are undertaking we are being told
of this or not that, this or not that, that kind of uncertainty possibly as you be going through the
country you find that some people have broke out that is one of the major contributions so at
least as we are focusing towards this training let us be specific to say people are training for
BSC other than saying no its advanced diploma, BSC no this no that so that kind of a shaky
environment does not allow people to fully focus on what they are doing.” [CP-002]
Another concern that was reported by all participants was lack of or insufficient supervision.
Participants reported that whilst they were implementing some of the skills that they have
acquired through the ETATMBA training, lack of supervision was their concern because they
were just doing things without even knowing whether they are doing the right thing or not.
“No, but maybe if I can expand it no changes so far but I will be very happy if we have got our
local tutors here if at least once in a while could visit us after maybe the training they could visit
us at their own time to see what we are doing and maybe to appreciate or tell us how we should
do it better rather than meeting them only in training then we leave and we meet them again on
the other training”[KK-002]
4. Conclusion
Overall the trainees seemed to be satisfied with the training. The training had been reported to be
beneficial by all participants. However there is need to clear out the concerns reported by the
trainees in the following training sessions.