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Impact and sustainability of master trainer-led obstetric emergency skills training in Uganda: a qualitative study
Rebecca Hakim1,2, Helen Bailey2,3, Nishel Mohan Shah4
1Department of Trauma and Orthopaedics, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom.
Background:
Maternal mortality remains a major challenge in Uganda, where the maternal mortality ratio is 189 per 100,000 births - fifty time higher than in the UK. The Royal College of Obstetricians and Gynaecologists' Excellence in Obstetric Skills (EOS) and Resilience in Obstetric Skills (ROS) courses used a train-the-trainer model, creating locally based Master Trainers (MTs), to strengthen management of obstetric emergencies in Uganda. This qualitative study explored the perceived impact, benefits and sustainability of these courses from the perspectives of Ugandan MTs and UK-based stakeholders.
Methods:
A descriptive, cross-sectional qualitative study using semi-structured interviews was conducted with seven purposively sampled participants: five Ugandan MTs and two UK-based stakeholders involved in the programme's development or support. Interviews were conducted via Zoom, transcribed, anonymised and analysed using inductive thematic analysis, following Braun and Clarke's approach, by two independent researchers, with disagreements resolved by discussion and input from senior authors.
Results:
Four overarching themes were identified: expected outcomes including improved clinical knowledge, escalation and knowledge cascading; unexpected outcomes including career development, improved patient communication and enhanced physical environments; challenges, including variable skills uptake, course duration, funding constraints and staff attrition; and sustainability, spanning funding, government accreditation, workforce retention, mentorship and integration into continuing professional development. Participants perceived increased confidence in managing emergencies and anecdotal reductions in maternal mortality, alongside persistent barriers including a lack of formal accreditation, inconsistent funding and understaffing that limited lasting impact.
Conclusions:
Participants perceived the EOS/ROS courses to have benefits beyond clinical skills. Reported improvements in maternal care and mortality were anecdotal and do not establish a causal relationship. Sustainable delivery of the Master Trainer model may require formal accreditation, dedicated funding and integration into continuing professional development and ongoing skills development.