Emergency Obstetric Training in Uganda

The Change Exchange consultants, Amy Burton, Fiona Gillison & Nisha Sharma, with Royal College of Obstetrics & Gynaecology, UK and Kitovu Hospital, Uganda

The challenge

The health partnership, between The Royal College of Obstetricians and Gynaecologists (RCOG) and Kitovu Hospital in Uganda, co-ordinates and delivers a training package ‘Excellence in: Obstetric Skills’, which included lectures, workshops, and practical activities to educate midwives and doctors in essential obstetric care with an emphasis on fistula prevention.  The projects wanted to know whether their training was likely to change practice and, in particular, how they could enhance the action planning intervention they had developed as part of the course.  They were also interested in how train the trainers programmes could be enhanced with behavioural science.

Our work

We spent 8 month working with the partnership, during which three behavioural scientist volunteers spent time in Uganda on three separate visits.  We gathered knowledge about how the course was delivered, to review whether known psychological behaviour change techniques (BCT) were being used, and to work with the Ugandan trainees to explore the barriers to implementing what they had learnt into practice.  We coded sessions for behaviour change techniques, and established that most were used to support capability with opportunity and motivation targeted techniques less frequently employed. 

On the basis of our findings, and solid behavioural science theory and evidence, we made recommendations to the RCOG for changes to the next iteration of the course.  These included incorporating: action planning to incorporate SMART goals, ways of fostering social support (e.g., through Facebook and WhatsApp groups that could be accessed from even the most remote areas), posters as motivators and behavioural cues to be displayed in health centres, and recommendations to embed education in behaviour change techniques into the materials for course facilitators.  We developed training for the train the trainers programme which introduced concepts of behaviour change and techniques to improve the capability, opportunity and motivation of trainees to make practice changes.

We wrote three reports for the partners which they used to understand our work and the impact of their course on practice.

The benefits

Benefits were a profound shift in how the UK partners saw their activities.  The Global Health Unit administrator for Royal College of Obstetrics and Gynaecology said:

I think from our perspective it was like a piece of the puzzle that had been missing that we hadn’t realised and … I think every project is trying to make changes to behaviour and without understanding what that is and what that looks like then they are not really going to get anywhere so I think it is a really fundamental part to the work that we are trying to do.

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