Table 1 Summary description of intervention in Rajasthan as of January 2019

Intervention hospitals

Over 200, including District hospitals, Sub-district hospitals, and high delivery load Community Health Centres and Primary Health Centres.

Support from technical partner

They conducted rapid assessments of infrastructure and resources and suggested improvements for better preparedness before training. They trained Government identified Dakshata trainers in each district and supervised the training of the obstetric staff. They helped in micro-planning of training and facilitated the operations as per the rosters. They mentored and conducted periodic assessments at the facility level; regularly provided feedback to hospitals, district, and state administration.

Bulk training

Training included the use of SCC, and the advancement of clinical knowledge and skills for risk assessment, the conduct of vaginal delivery, infection control, and management of common complications of the mother, birth asphyxia, and newborn hypothermia. It also covered referral criteria and pre-referral stabilizing care. The trainers conducted Pre- and Post- OSCIs to measure the effect of training and provided feedback to the trainees.

Pulse mentoring

Mentoring consisted of pulse training, mock-drills, and feedback for corrections; also consultation to ensure the availability of essential resources. Mentors used a structured mentoring package (8 visits later consolidated to 5). Once this package was completed, mentors continued to provide need-based mentoring based on the specific gaps identified from periodic assessments.

Periodic assessments

They scored the performance (using a 19-point composite score), identified gaps, provided feedback, and implemented corrections. The mentors used a mobile-based software application that provided a summary report in real-time which was also available to the program managers in the district and state.

Monitoring and supervision by state

The team from JHPIEGO monitored and provided feedback to the state and district department. The Government maternal health officers in state directly monitored the mentoring and performance of the facilities. They acknowledged and rewarded the better performing labour room teams, and also provided support where required.

Phase out

Phase-out was planned for October 2019. During phase-out and handover to the state, the government recruited 17 mentors who interned under JHPIEGO mentors for 2 months, before taking up complete handover. Additionally, the state identified block (sub-district) mentors from the in-service obstetric teams, who were trained by JHPIEGO mentors and were to provide clinical support and mentoring to 2–3 facilities in their region. These mentors were expected to be self-sufficient. The state and district administration acquired management, supervision, and monitoring responsibilities.