SIMESON: training of birth attendants in remote areas

Through the SIMESON approach (Simulation of Essential Skills in Obstetrical and Neonatal care), Tdh has trained midwifes and health workers in public health facilities of Mali, Guinea, Nepal and Bangladesh to make sustainable improvements to the quality of care provided at birth with links to the prenatal and postnatal care.

In isolated areas characterised by deep and chronic poverty, access to basic health services, in particular maternal and neonatal care, is of serious concern. A shortage of qualified health workers makes the follow-up of pregnancies and giving birth in good conditions almost impossible. Maternal mortality is mainly due to postpartum haemorrhage, followed by infections and high blood pressure, while neonatal mortality is mainly caused by the complications of prematurity, infections or complications during childbirth. The training content of the SIMESON approach is based on WHO guidelines and adapted to national requirements including the needed modules to address the main issues affecting babies and their mothers at birth. 

In these settings with difficult access to quality health care, mothers and their babies are the most vulnerable, particularly at birth. Tdh is committed to their survival and wellbeing. It is with this background that the SIMESON approach was firstly developed in Mali in order to reduce stillbirths as well as neonatal and maternal mortality. 

Tdh understands the crucial role that water, sanitation and hygiene (WASH) plays in ensuring and sustaining maternal and new-born health outcomes, therefore Tdh has developed a digital tool called FACET to assess water conditions and services at the primary health care facilities, with a focus on the delivery room. Targeted interventions are then implemented to improve their WASH conditions. Tdh also contributes, when needed, in supplying medical commodities to ensure health workers have the necessary tools and equipment to provide quality care. 

Training health workers to make a difference 

As quality of care at birth is strongly determined by health workers' skills, it is essential to develop and maintain these competencies through regular trainings. Practical trainings can be performed on mannequins to learn and improve procedures that allow midwives to attend births safely and help newborns to adjust seamlessly to their new lives. These medical simulation techniques make it possible to repeat and control stressful situations without endangering patients' lives. This method, used already in large centres, is now made available by Tdh to birth attendants in peripheral settings: our mobile staff visits every health centre of a whole health district at least once every month to run practical and individual trainings. “Tdh (SIMESON) worked as a supplementary training, which has filled up my shortcomings in conducting normal delivery.” - Bangladesh Healthcare worker.