Building capacity for skilled birth attendance: An evaluation of the Maternal and Child Health Aides training programme in Sierra Leone.

Objective: Maternal and Child Health Aides (MCH Aide) in Sierra Leone provide the majority of maternity services at primary care level. To formulate recommendations for improving the quality and scale-up of MCH Aides training an evaluation of all schools across Sierra Leone was undertaken.

Design: Structured, direct observation of two randomly selected teaching sessions per school using pre-tested standardised review forms. Event sampling with random selection of timetabled sessions across all 14 MCH Aide Training Schools.

Setting: All MCH Aide training schools across Sierra Leone.

Participants: Tutors across 14 MCH Aide training schools observed in August 2013.

Measurements: Assessment of four key elements of teaching and learning: (1) teaching style, (2) use of visual aids, (3) teaching environment and (4) student involvement.

Findings: In the majority of teaching schools there was over-crowding (11/14), lack of furniture and inconsistent electricity supply. Ten of 26 tutors used lesson plans and teaching was mostly tutor- rather than student-focused. Majority of tutors use a didactic approach rather than active learning methods. Teaching aides were rarely available (15% of lessons). Tutors were knowledgeable in their subject area and there was evidence of an excellent tutor-student relationship.

Key Conclusions: Training for Maternal and Child health Aides relies on teacher focused didactic methods, which may hinder student learning. Teaching and learning within the schools needs to be enhanced by a combination of tutor development and improvements in the learning environment.

Implications For Practice: Interventions to improve the quality of teaching are urgently needed and should include training on teaching techniques and student assessment for tutors, provision of audio visual equipment and teaching aides such as posters and mannequins. Monitoring and Evaluation of interventions is critical to be able to amend the programmes approach and address further challenges at an early stage.