AUTHOR=Leader Alexandra , Cadet Claudia , Lazala Davina , Roa Wanny , Arroyo Olga , Jensen Lloyd 

TITLE=Collaborative Implementation Strategy for Newborn Resuscitation and Essential Care Training in the Dominican Republic

JOURNAL=Frontiers in Public Health

VOLUME=Volume 5 - 2017

YEAR=2017

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2017.00061

DOI=10.3389/fpubh.2017.00061

ISSN=2296-2565

ABSTRACT=Background: Neonatal mortality accounts for 45% of under-5 mortality worldwide, with 98% of newborn deaths occurring in developing countries. The Dominican Republic (DR) demonstrates one of the highest neonatal mortality rates in Latin America despite broad access to care. Strategies to support professional capacity-building and strengthen the local health care system are needed to improve neonatal outcomes in the DR.        
Rationale: Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) are evidence-based newborn resuscitation and essential care training programs that have been shown to improve providers’ confidence, knowledge and clinical skills. Lack of professional support and infrequent resuscitation skills practice are cited as barriers to skill retention after HBB training, while establishment of program mentoring and skills refreshers are associated with clinical knowledge and skills retention and improved clinical outcomes. Implementation of a comprehensive newborn resuscitation and essential care training program that facilitates continuing education and program mentorship in the DR should have a lasting impact on workforce capacity, quality of care, and clinical outcomes through partnerships that strengthen the local health care system.
Methods: An international group of clinicians partnered with the Ministry of Health to implement a comprehensive newborn health initiative in the DR. A train-the-trainer model structured the regional rollout of a HBB/ECEB program with integrated quality improvement initiatives for program monitoring, reinforcement, and mentorship. Cognitive, affective, behavioral, and clinical outcomes are measured.  
Results: 17 local champions representing 6 hospitals participated in the HBB/ECEB Master Trainer course and design of quality improvement tool for clinical performance monitoring. 178 and 171 providers participated in HBB and ECEB courses, respectively, at pilot sites during the following year. Participants completed prior training needs assessment, pre/post knowledge assessments, and course evaluations. Program mentorship and monitoring of continuing education and clinical performance is ongoing. The Ministry of Health has assumed responsibility for program sustainability and current scale-up, including integration of maternal resuscitation training. 
Conclusions: International partnerships facilitated the collaborative implementation of scalable, locally sustained newborn resuscitation and essential care training in the DR, mobilizing local resources and empowering the workforce to capably pursue improved care of an exceedingly vulnerable community.