The Government of India (GoI) is highly committed to ensuring universal coverage of all births with skilled attendance, both at the institutional and community level, thereby reducing maternal and newborn deaths in the country. Since any woman with a pregnancy can develop complications at any stage, the timely provision of skilled obstetric services is essential for the management of such complications. GoI envisions that every pregnant woman should be cared for by an SBA during pregnancy, childbirth and the postpartum period.

Uttar Pradesh (UP), with a population of 235 million and 6 million pregnancies in a year, contributes to 9K+ maternal and 160K+ neonatal deaths annually. The institutional delivery rate in UP, as per NFHS 5, is 83.4 %, and that in public health facilities is 57.7%. There is an urgent need to provide rapid and quality training to the remaining 8K+ staff nurses and ANMs of the total 12K+ posted at delivery points to achieve the SDG targets of MMR and NMR.

Given this context, a robust, rapidly scalable training program for the in-service staff was considered crucial to UP. A cluster-based training approach was designed to simultaneously train service providers in multiples of 4 at several training sites while maintaining the original design of 21 days of training in batches of 4 with no extra financial cost to the system. The other system-level strengthening such as having permanent specialist doctors, task shifting to MBBS doctors via the Buddy-buddy model, having trained nurse mentors and mini-skill labs at all districts hospitals and CHCs, activation of new CHC FRUs, having all drugs under essential drug list available at facilities via the UPMSCL and having unique eHRMS codes for all health care providers were all leveraged in planning and execution of this training. The parallel system level strengthening has also enabled skilled birth attendants to provide quality services after the training.

Through the cluster-based approach, UP currently has 265 SBA training sites across the state and 1272 district-level master trainers. From November 2022 to March 2024, around 6,300 delivery point staff were trained.

This brief highlights the cluster model approach adopted by UP TSU in scaling up the SBA training in the state.

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