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Frontline health care workers in Nigeria

Frontline health care workers in Nigeria undergo training in ENC Now! Courtesy of InSiGHt Health Consulting, Ltd.

Newborn care course achieves milestone with digital training, remote facilitation

December 16, 2021

A novel essential newborn care teaching program from the AAP and its partners features digital training and implementation, allowing for remote facilitation from anywhere in the world.

ENC Now! (Essential Newborn Care Now! at, which launched in November, is based on the World Health Organization’s Essential Newborn Care course and adapted from the AAP’s evidence-based Helping Babies Survive (HBS) program suite for resource-limited areas.

Doctor working on newborn

Extending the reach

During the pandemic, travel restrictions and physical distancing policies temporarily halted newborn resuscitation training. Experts say ENC Now! overcomes many of the challenges by making the education more flexible for learners and reducing the costs of travel, venue, monitoring and evaluation.

“The pandemic really did highlight not just the need, but the urgency for the program,” said Danielle Ehret, M.D., M.P.H., FAAP, a neonatologist and co-chair of the HBS Planning Group.

The training also can reach health workers in conflict areas. It is another methodology for teaching when face-to-face education is unsafe or impossible, Dr. Ehret noted.

HBS training materials traditionally focused on face-to-face education. ENC Now! provides a platform in which this facilitation can be done virtually, which has allowed farther reach, especially in these difficult times, she said.

Such online training “is vital, a gamechanger,” said Ashish K.C., M.B.B.S., M.H.C.M., Ph.D., associate professor of global health and pediatrics at Uppsala University in Sweden and a member of the HBS planning group. He is implementing ENC Now! in Nepal, one of five countries where the program is in operation.

The AAP received a grant from the Bill and Melinda Gates Foundation to test the feasibility of ENC Now! training to alter educational and clinical outcomes. AAP staff and technical advisers are running trainings in Nigeria and Bangladesh in conjunction with master trainers from the pediatric associations in those countries.

Blended learning

For the face-to-face practice time, learners participate from a hospital or other facility and receive support from a local and/or remote facilitator.

The facilitators use a camera or video to demonstrate procedures and skills. Afterward, participants work in pairs, discussing the training as they help each other. The course can be a full-day training or divided into shorter sessions over time.

Hard copy flipcharts are replaced by a digital flipchart with links to pre- and post-knowledge tests, content, skills demonstration and hands-on participation, and group discussions. There are six chapters, and reflection questions appear at the end of each section.

Online features of ENC Now! include language translation, a group chat app, an annotate function and a whiteboard function. Another feature, a pin function, can highlight for the entire group something learners are doing especially well. In addition, learners can access audio files of newborn heartbeats to determine if the heart is beating too slowly.

The group chat allows learners to share a video of the facility where they are working and showcase specific skills.

Finally, built-in QR codes make it easy for participants to pull up checklists and evaluations, one of the functions that Dr. K.C. finds especially helpful.

Global mentoring option

Because behavioral change is hard to sustain — and training alone often is not sufficient — the AAP also is offering a fee-based mentorship and implementation curriculum to complement ENC Now!

The Customized MentoRship and Implementation Support Package (CRISP) aims to translate training into sustained practice and improve newborn outcomes. CRISP includes added sessions on quality improvement, facilitator development and data collection.

A group of six to eight learners is paired with a global mentor who conducts ENC Now! training and a needs assessment to customize an additional four to six sessions of 60 to 90 minutes each. Sessions with mentors are interactive, and learners can bring examples and challenges to discuss.

Global support

In addition to the technological innovations, ENC Now! allows for a rich kind of mentorship relationship and co-facilitation, Dr. Ehret said.

“That really has the opportunity to help in the professional development of new trainers, new facilitators and mentors to feel like they can have support from their colleagues — wherever they may be globally, as they’re starting to teach courses. I think a new opportunity for mentorship is really unique and exciting about this program.”



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