Content and design of respectful maternity care training packages for health workers in sub-Saharan Africa: Scoping review

Abstract

Background: Training health workers might facilitate respectful maternity care (RMC); however, the content and design of RMC training remain unclear.

Objective: To explore the content and design of RMC training packages for health workers in sub-Saharan Africa.

Search strategy: MEDLINE, EMBASE, CINAHL Complete, Web of Science Core Collections, SCOPUS, and grey literature sources (including websites of RMC-focused key organizations and Ministries of Health) were searched for journal papers, reports, and training guides from January 2006 up to August 2022.

Selection criteria: There were no restrictions on study designs, language, or health-worker cadre. Two reviewers independently screened results.

Data collection and analysis: Key data, including training content and methods used, were extracted and summarized.

Main results: Thirty-two citations from 26 studies/programs were identified (24 journal papers, 5 manuals/guides, 2 reports and 1 PhD thesis), with 27 citations from 22 studies informing the review findings. About half of all conducted studies were from East Africa. The most common topics in RMC trainings were communication, privacy and confidentiality, and human resources. Most trainings were multicomponent and appear to be largely in-service training. Health workers providing direct care to women, compared with non-clinical staff such as receptionists and cleaners, were the only recipients of training in most studies (81.8%). Two broad categories of training methods/tools were identified: workshop-based and action-based. Over 90% of the studies assessed impact of the training, with a majority focused on impacts on maternal health and care; however, half of the latter studies did not appear to have feedback mechanisms in place for implementing change.

Conclusions: The content and design of RMC training in sub-Saharan Africa are multifaceted, suggesting the complexity of implementing/promoting RMC. Some progress has been made; however, missed opportunities in training remain with respect to study populations, training topics, cadres, and feedback mechanisms.

Keywords: disrespect and abuse; health workers; respectful maternity care; sub‐Saharan Africa; training.

FIGURE 1

Flow chart of search results from all data sources. a: One citation from the HEARD Project is a pack of 7 manuals/guides and powerpoint presentations from the Heshima Project. These have been counted as one citation in the flowchart, as they are multiple resources within a single study. b: This citation from the ICM is a pack of 3 manuals/guides and powerpoint presentation from the RESPECT toolkit. These have been counted as one citation in the flowchart, as they are multiple resources within a single study. c: Breakdown of MoH reports gotten: East Africa (3 Ethiopia, 6 Kenya, 1 Madagascar, 4 Tanzania, 7 Uganda); Central Africa (3 Equatorial Guinea, 3 Congo Republic, 1 Burundi); Southern Africa (7 Mozambique, 13 South Africa); West Africa (2 Burkina Faso, 1 multi‐country including Guinea, Ghana and Nigeria, and 1 pan‐African). d: 2 training manuals, 1 PhD thesis and 1 journal paper retrieved from screening reference lists.