About

Dr. Adyemi is a Senior Program Manager at the Clinton Health Access Initiative (CHAI) in Nigeria, overseeing the Group Antenatal Health and Maternal Mental Health programs. He leads the team supporting the implementation of the Safer Birth Bundle of Care in Gombe state. We asked him about his experiences with the recent implementation, outcomes, and hopes for the future.

Can you provide a brief overview of the efforts being made to improve newborn and maternal health in Nigeria?

Nigeria is one of the highest burden countries for maternal and newborn morbidity and mortality. The government of Nigeria has implemented many interventions and initiatives, in collaboration with partners, to improve maternal and newborn health outcomes. Recently, one major initiative by the government is the Maternal and Neonatal Mortality Innovations and Initiatives (MAMII), which aims to pilot evidence-based, impactful, and context-specific interventions to drive down the high maternal and newborn deaths in the country. This, and other result-oriented interventions, are intended to foster better collaboration and integration of efforts by the government, partners, and donors for collective impact in improving the healthcare system in Nigeria.

Healthcare systems in low- and middle-income countries face implementation challenges. How do you believe this can be improved?

Challenges faced in program implementation include funding and resource allocations, access and equity, workforce issues, program fragmentation, and so on. However, there are strategies that could mitigate or address these challenges. These include ownership and commitment of governments in driving programs, with a strong health financing and resource mobilization base. This, in addition to embedding sustainability plans in these programs for sustained impact. The integration of programs and structures cannot be overemphasized in achieving impact and addressing challenges such as funding. Improving the management capacity of health program managers as well as building the capacity of health providers, and the involvement and engagement of communities, are approaches that not only improve access and uptake of health services but address the quality and equity of care and service. In all, an iterative process with strategic feedback mechanisms in place provides a platform to pause, review, and re-strategize  implementation approaches to get the best outcome of any program.

Could you explain how the training was implemented – both in terms of content and methodology? 

The Safer Births Bundle of Care training is very innovative, and the methodology uses a human-centered approach to learning, allowing participants to make use of a simulation-based training approach to learn, and reinforce learning. The approach allows learners to make mistakes and helps them identify these mistakes using digital devices and mannikins to course correct. Self-evaluation and feedback build the confidence of learners. The training includes the theoretical presentation of the SBBC approach where participants are taken through continuous quality improvement, fidelity, and sustainability of the SBBC program. 

The first training phase had 11 state master trainers selected from a pool of skilled trainers in the state (consisting of obstetricians, gynecologists, pediatricians, and other professional healthcare providers). The second phase had 33 facility champions drawn from the labor and delivery department. All trainees were taken through a simulation introduction course, the SimBegin course, with online pre-training assessment to determine their competency and area of concentration for each training module. These trainings were co-facilitated by the Haydom Lutheran Hospital from Tanzania and the Laerdal Global Health team. Clinical innovations such as the Moyo Fetal Heart Rate monitor, and the Neobeat newborn heart rate meter, as well as the training innovations such as the Neonatalie Live Ventilator and MamaNatalie simulator were demonstrated and practiced by the trainees using mannikins and on live volunteers. 

Sessions on data management, including data collection and analysis, for quality improvement, are essential for increasing newborn and maternal survival. The facilitators trained the participants in the simulation methodology using the CORE (Context, Observations, Reflections, Enhancing practice) cue cards. The learners rehearsed, prepared, and delivered a pre-made simulation. The simulation scenarios focused on using the recommended training materials (including BEmONC/HMS BABC, PPH, ENCC training). The training was hands-on, where every learner got to demonstrate scenarios and practice sessions to improve skills and knowledge.

In what ways did the success of the SBBC program in Tanzania facilitate its adoption in Nigeria?

The result of the SBBC program implemented in Tanzania is a testament to how impactful the approach is in reducing maternal and newborn deaths in a resource-deficient setting. The evidence-based approach has shown promise for countries with similar demographics to adopt or adapt the model and replicate the achievements recorded. This has been the driving force for the collaborative effort between CHAI, LGH, and the Government of Gombe State to implement this program in the state and reduce maternal and newborn mortality, which is a priority for the state government. There is a positive outlook to scaling up this program and using the evidence from its implementation to advocate for national adoption through the Federal Ministry of Health. 

How is CHAI working in partnership with the SBBC program?

CHAI is collaborating with Laerdal Global Health to support the Gombe State Government in implementing the SBBC approach in selected facilities in the state, leveraging the CHAI’s existing program. In addition to this collaboration, Haydom Lutheran Hospital is providing technical support with the SBBC training resources, like sample training curriculum and schedules, and remote or in-person facilitation of training.

What role does the Gombe State government play in supporting the implementation? How important is local ownership for the sustainability of programs?

The Government of Gombe State is playing an important role and has been actively engaged in the implementation process. The State’s interest initiated from advocacy and most importantly, the existing evidence resulting from previous implementation led to the government’s buy-in and commitment to support the process. This ownership and commitment have led to the inclusion of SBBC-focused activities and the equipment into the State's 2025 annual operational plan, and inclusion of SBBC training into the State Nursing and Midwifery pre-service scheme. The State has also shown leadership in the program implementation through the selection and release for engagement, of the state master trainers, from the existing pool of experienced and skilled facilitators. These have shown the government’s commitment to adopt and scale up the SBBC program in the State.

What challenges have healthcare providers faced, and how do you think the SBBC and SimBegin trainings help address these issues?

Healthcare providers face several challenges, including inadequate infrastructure—such as a lack of advanced equipment—and a shortage of skilled personnel to deliver high-quality services effectively. The SBBC approach addresses these issues by implementing facility-based simulation training through the low-dose, high-frequency method, helping healthcare workers enhance and sustain their skills and competence. Furthermore, continuous quality improvement solutions, driven by data feedback loops from these simulations, allow supervisors and mentors to identify and address knowledge gaps among healthcare providers. Ultimately, this structured approach fosters the confidence and proficiency of healthcare workers in providing top-notch services. In addition, employing the SBBC devices improves the quality of care, eases the workload of healthcare workers, and enhances the overall client experience in care. 

How has the integration of digital tools and platforms, such as LIFT assessments, been experienced by participants during the training and assessment process?

The integration of digital tools and platforms allowed participants to assess their knowledge and competence, evaluate their performance, and enhance their skills. The pre-developed scenarios helped them to facilitate clinic sessions, follow prescribed sequences, evaluate processes, and course correct.

How did you and the other participants perceive the hands-on simulation-based training?

We were excited to use clinical equipment (Moyo fetal heart rate and Neobeat newborn heart rate monitors) and mannequins. The experience of using NeoNatalie live for resuscitation and MamaNatalie to practice prevention and management of postpartum hemmorhage was exceptional.

How did you and the other participants experience the clinical debriefing, and what were some of the most meaningful insights that emerged from these discussions?

At the clinical debriefing one of the facility champions called the learning methodology "superb.” She went on to say that the approach provides equal opportunities for every participant to interact, engage, and practice. The most interesting aspect is the unique feedback mechanism embedded through briefing and debriefing during the simulation. She was especially impressed that you could evaluate yourself on what went well and what you could have done better, free from prejudice.

What do you see as key elements for the Safer Births Bundle of Care program to be successful in Nigeria – and elsewhere?

The training methodology, using a simulation-based approach and the facility-based low-dose-high-frequency training plan, along with the use of innovative equipment, can be applied across all healthcare facilities in diverse settings to promote ongoing learning. Incorporating the SBBC training module and equipment into pre-service training would better equip and prepare providers for effective and quality delivery of services.