An AAP training program designed to improve newborn survival rates in Morocco was a “transformative” experience, according to one of the project’s coordinators.
“Witnessing the impact of the training on the participants was incredibly rewarding,” said Angelique Mugirente, one of five global mentors who joined two AAP staff members earlier this year for the Essential Newborn Care (ENC) Project in Morocco. The project was created in conjunction with Operation Smile Morocco and Association Marocaine des sages femmes.
Thirty midwives from all 12 regions of the country trained over five days in the World Health Organization’s (WHO’s) ENC 1 course, focusing on the first 60 minutes of an infant’s life.
“This experience significantly enriched my perspective on global health and solidified my belief in the power of collaborative learning and cross-cultural exchange,” said Mugirente, a Rwandan resident who has worked as both a nurse and midwife.
Morocco, a country of 37.5 million people, is in dire need of nurses and midwives. According to an April report by CEOWORLD, Morocco ranks 45th among the 193 world nations most in need of such practitioners, with just 14 midwives and nurses for every 10,000 people, according to 2022 figures from the World Bank.
“For the participants and the country, these sessions provided a unique opportunity to gain advanced skills and knowledge critical for improving neonatal and maternal health outcomes,” Mugirente said. “The exchange of best practices and the hands-on training were invaluable for building local capacity.”
Essential care, continued mentorship
The AAP created the Helping Babies Breathe (HBB) course in 2010 as part of a larger effort to improve neonatal resuscitation and newborn care. The HBB methodology was incorporated in 2023 into the WHO’s Essential Newborn Care Course (ENCC), which includes “Immediate Care and Helping Babies Breathe” (ENC 1) and “Assessment and Continued Care” (ENC 2).
“ENC 1 includes what we call family-centered care, which is a really new idea in most of the world,” said Carlos G. Ramos, M.D., FAAP, a global mentor and neonatologist from California. “Having the father of the baby present at the time of birth is still a challenge in conservative cultures like Morocco, because there’s still that strong gender separation.”
The course includes hands-on training and simulation.
“Skills and techniques that were prioritized included quick evaluation, neonatal resuscitation, infection control and timely decision-making to escalate care,” said Mugirente.
Ventilation techniques needed special attention, Dr. Ramos said.
“The most important step at birth is for the babies to breathe,” he said. “Either they do it by themselves, or we help them. So mastering the bag and the mask to do ventilation, that requires quite a lot of effort in training.”
Data collection was another key component, as “in many places — low-resource settings, for sure — the importance (put on) collecting data to improve care is not quite there yet,” Dr. Ramos said.
Trainees will put that data to use as their learning continues.
“The beauty of what the Academy is doing now is that there is actually mentorship that continues,” Dr. Ramos said.
He and the other global mentors meet virtually once a month with the participants as part of the AAP’s Customized mentoRship and Implementation Support Package. Monthly meetings include sessions on how to implement and continue improving the ENC 1 program as the midwives share knowledge with their peers.
One of the goals of the project at the concept stage was to improve the newborn resuscitation skills of 1,000 nurses and midwives in one year.
“We aim to expand the program to reach more health care professionals across the country and different regions,” Mugirente said. “This includes not only midwives but also other key personnel involved in neonatal care.”
Inspiration for the future
Mugirente would like to see ENC 1 training continue to spread across the globe.
“Countries across sub-Saharan Africa, Southeast Asia and Latin America face similar challenges in neonatal and maternal health care,” she said. “By extending this training to these regions, we can help build local capacity, improve health outcomes and save countless lives. The success of the training in Morocco serves as a compelling model for what can be achieved with the right support and collaboration.”
The Morocco trainees continue to impress their mentors. “I’m really proud of them,” Dr. Ramos said. “They are really teaching the junior midwives and midwife students, and they keep sharing all those trainings with us.”
Mugirente called the trainees’ dedication “inspiring.”
“Their willingness to learn and improve their skills was truly motivating. It was incredibly fulfilling to see the immediate impact of the training,” she said.
Resources
