Perceived barriers faced by trainers in developing essential newborn care training to the healthcare workers in Nepal.

Research Report.

ABSTRACT: Background: Nepal has made significant progress in reducing the child mortality ratio but neonatal mortality declined only at a slow pace. Effective training for health workers on the aspects of essential newborn care is particularly vital to ensure the survival and well-being of newborns. However, the challenges faced by those who offer the ENC training to health workers often do not get enough recognition in the literature. Objective: This study sought to elicit the views of ENC trainers in the Kathmandu Valley on perceived barriers faced in delivering ENC training to the healthcare workers in Nepal. Study design: Semi-structured interviews were conducted with 16 trainers using a set of both open- and close-ended questionnaires developed in English. Interviews were audio-recorded, transcribed verbatim and then thematically analysed using the interview transcripts. Results: The interviews highlighted various barriers that were perceived to hinder effective ENC training in Nepal, including human resources challenges, funding problems, inadequate training resources, negative attitude of trainees, lack of training activities monitoring and lack of government commitment. Human resource constraints faced include shortage of manpower, frequent inter-department transfer of staff and inappropriate trainee selection for training compromises the value of providing training. Trainers faced with problems getting sufficient materials and equipment for training. Insufficient funding and donor dependence make the training unsustainable. Trainers are faced with uninterested trainees who only come for monetary incentives and unreceptive trainees who still hold on to their strong traditional beliefs and practices. Irregular refresher courses and post-training follow up are not available due to lack of monitoring. Lack of government commitment towards mandatory training for healthcare workers was also perceived as barrier to the successful implementation of ENC training in Nepal. Conclusion: This study highlights a multitude of barriers and provides valuable insight into the trainers' perceived barriers in provision of ENC training. Greater government and NGO commitment can ensure better availability of human resources, funding and systems to ensure the sustainability and value of the ENC training programme.