Skilled Providers

by | Mar 24, 2025

Maternal, Newborn, and Child Health

MNCH Health Systems Strengthening Interventions

Maternal, Newborn, and Child Health

MNCH Health Systems Strengthening Interventions

Skilled Providers

The Backbone of the MNCH Workforce

A skilled and well-supported health workforce is essential for delivering high-quality maternal, newborn, and child health (MNCH) services across the continuum of care – from preconception through pregnancy, childbirth, and the postnatal period. The MNCH workforce includes doctors, nurses, midwives, clinical officers, and community health workers, depending on the country context. These providers must be formally educated, trained, and regulated in accordance with national and international standards, such as those outlined by the World Health Organization (WHO).

Investing in skilled health providers not only strengthens the health system but also leads to significant improvements in maternal and newborn outcomes, reducing preventable morbidity and mortality. Skilled providers are often the first line of defense in detecting complications, offering respectful care, and initiating lifesaving interventions.

To ensure quality and continuity of MNCH services, skilled providers should be competent in:

  • Delivering evidence-based, respectful, and culturally sensitive care to women and newborns.
  • Providing comprehensive antenatal services, including pregnancy care and family planning counseling.
  • Managing labor and delivery to ensure safe births and positive childbirth experiences.
  • Delivering postnatal care, including vaccinations and health education for mothers and infants.
  • Performing emergency obstetric and newborn care (EmONC) when complications arise.
  • Identifying, managing, or referring high-risk cases and complications.
  • Delivering care in humanitarian, fragile, and conflict-affected settings, where conditions may be more complex and resources limited.

This section emphasizes the importance of training, mentoring, regulation, and ongoing professional development to ensure that MNCH providers are equipped to offer safe, compassionate, and lifesaving care in all contexts.

What Are the Benefits of Strengthening Provider Capacity?

Building the capacity of the MNCH workforce is critical to ensuring that mothers and their newborns receive high-quality, timely care across the continuum of life. Despite investments by many local governments, significant challenges remain. These include persistent staff shortages and high attrition, as well as limited capacity among existing providers to deliver essential and emergency obstetric and newborn care.

Access to in-service training remains a major barrier, particularly due to the high cost of traditional training programs, which limits opportunities for professional development. As a result, many healthcare providers are ill-equipped to manage high-risk pregnancies and complications during delivery. Compounding the issue is the lack of awareness of current evidence-based practices and the absence of integrated MNCH toolkits to support standardized service delivery.

To bridge these quality of care gaps and scale up evidence-based MNCH interventions, there is a growing need to invest in low-cost, practical in-service training modalities. These approaches not only supplement pre-service education but also strengthen on-the-job competencies in a cost-effective and sustainable way. Developing a dedicated and well-trained MNCH workforce leads to improved provider confidence, more consistent use of high-impact practices, and ultimately, better health outcomes for women and children. Having skilled MNCH providers will:

How to Implement

1. Use National Guidelines and Standards
  • Familiarize yourself with your country’s MNCH clinical guidelines and performance standards. These define essential competencies for service delivery and are based on WHO recommendations.
  • Support the dissemination and use of guidelines, job aids, and protocols in your facility.
  • If gaps exist in implementation, conduct sensitization, coaching, or mentorship to help colleagues understand and apply the guidelines effectively.
2. Conduct Initial and Refresher Training
  • Assess the training needs of staff before any intervention.
  • Deliver orientation, workshops, or full training sessions based on national protocols.
  • Use on-the-job training (OJT) methods such as coaching and mentorship to build real-time skills.
  • Offer refresher training periodically via in-person sessions, mobile apps, or platforms like TCI University.
3. Support Ongoing Professional Development (CPD)
  • Organize regular continuing professional development (CPD) or continuing medical education (CME) sessions, coaching, and mentorship on emerging MNCH issues.
  • Facilitate provider participation in conferences, webinars, and exchange visits.
  • Encourage peer-to-peer learning within and across facilities and geographies.
4. Strengthen Mentorship and Supportive Supervision
  • Establish a structured mentorship program where experienced providers guide junior staff.
  • Conduct regular supervision with a focus on:
    • Timeliness of feedback.
    • Data-driven performance goals.
    • Quality of care.
    • Client-centered focus.
    • Service delivery outcomes.
5. Promote Respectful, Client-Centered Care
  • Treat every client with dignity, respect, and confidentiality.
  • Ensure informed consent, listen actively, and tailor services to each client’s needs.
  • Create a welcoming environment for vulnerable and marginalized populations.
  • Refer to WHO’s respectful maternity care framework for implementation support.
6. Involve Male Partners in Care
  • Encourage male involvement in birth preparedness, ANC visits, and postnatal care.
  • Provide couples counseling where appropriate (e.g., for family planning and newborn care).
  • Address provider bias and create space for male partners’ participation when desired by the woman.
7. Deliver Quality MNCH Services Across the Continuum of Care
  • Ensure providers are trained in core competencies (see Tips box to the right) such as:
    • Taking histories and conducting physical exams.
    • Monitoring labor and managing complications.
    • Newborn resuscitation and immediate postnatal care.
    • Postpartum family planning.
    • Counseling and referrals.
  • Provide both preventive and curative services, including vaccinations and micronutrient supplementation.
8. Strengthen Referral Systems
  • Know when and where to refer clients who need care beyond your facility’s capacity.
  • Common referral reasons:
    • Obstetric/newborn emergencies.
    • Prolonged or complicated labor.
    • Stockouts of essential supplies.
    • Provider capacity limitations.
  • Ensure follow-up after referral is completed.
9. Practice Infection Prevention and Control (IPC)
  • Follow standard precautions for all clients, including: 
    • Handwashing.
    • Use of PPE (e.g., gloves).
    • Safe waste disposal and disinfection.
    • Proper sterilization of equipment.
  • Keep the facility environment clean and hygienic at all times.
10. Ensure Effective Client Follow-Up
  • Develop follow-up plans during ANC, delivery, and PNC.
  • Use community health workers or primary care givers to support follow-up at the community level.
  • Allow time for clients to ask questions and share experiences at each visit.
11. Maintain Strong Record-keeping and Reporting
  • Accurately record service data using national data capture tools.
  • Monitor and report on commodity stock levels.
  • Support supportive supervision and capacity-building of lower-level providers, including CHWs.
12. Embrace Innovation and Technology
  • Use telehealth or digital platforms for training, mentorship, and service delivery.
  • Explore simulation tools for advanced skill-building.
  • Use data dashboards and mobile job aids to support real-time decision-making.
13. Address Workforce Challenges and Motivation
  • Identify and respond to burnout, high attrition, and lack of motivation.
  • Implement provider recognition systems and promote work-life balance.
  • Foster a culture of continuous quality improvement and staff well-being.

Key Indicators

The indicators for providers’ knowledge and skills/practice will be tracked through:

  • Number of service providers trained/mentored /coached and competent to provide quality MNCH services along the continuum of care.
  • Provider knowledge of essential MNCH guidelines and protocols.
  • Health facilities with trained service providers to offer the signal functions.

Service coverage indicators are context-specific and generally organized in categories following the continuum of care (integrated service delivery for mothers and children from pre-pregnancy to delivery, the immediate postnatal period, and childhood) in the scorecards. They include:

 

Antenatal Care
  • Percentage of pregnant women receiving at least one antenatal care visit.
  • Percentage of pregnant women receiving 4+ ANC visits.
  • Proportion of women receiving essential antenatal care components like iron/folic acid supplementation, blood pressure monitoring, and HIV testing.
Delivery Care
  • Percentage of deliveries attended by a skilled birth attendant (doctor, midwife).
  • Caesarean section rate when medically indicated.
  • Newborn resuscitation practice.
Postnatal Care
  • Proportion of women receiving postnatal care by timings, i.e., within 48 hours of delivery.
  • Early initiation of breastfeeding counseling and support.
Newborn Health
  • Neonatal mortality rate.
  • Proportion of prenatal mortalities audited.
  • Early detection and management of newborn complications like sepsis, jaundice, and birth asphyxia.
Maternal Health
  • Maternal mortality ratio.
  • Proportion of maternal deaths audited.
  • Identification and management of pregnancy complications like preeclampsia and gestational diabetes.
Referral System
  • Timely referral of high-risk pregnancies and complications to appropriate healthcare facilities.

Test Your Knowledge
Earn a Certificate

Print Friendly, PDF & Email

MNCH Workforce Interventions

Program Area Home

Tips

Most maternal and newborn child health training programs are designed to be competency-based. Competency-based training is focused on developing and mastering the specific skills necessary to correctly conduct a set of tasks, functions, and/or core competencies according to predetermined standards for a particular job or set of responsibilities. Competency-based training places less emphasis on learning theoretical knowledge and more emphasis on skills acquisition, competence, and mastery of what participants must do after the learning event.  This type of training should prepare participants to perform individual tasks, to manage a range of tasks, and, perhaps most importantly, to have the critical thinking skills to respond flexibly and appropriately in the post-training environment, even if it varies from the training environment. An example is the BEmONC training that focuses on equipping the service providers with life-saving interventions for major causes of maternal and perinatal morbidities and mortalities.

r

Challenges

    • Inadequate Capacity: Health workers require the necessary knowledge, skills, protection, motivation, and support to deliver quality MNCH care. To sustainably build capacity and maintain both quality and motivation among health workers, supervision should be supportive and encourage open discussions on clinical practices. Peer support through coaching and mentorship can be implemented to address capacity gaps and enhance the quality of care. Additionally, opportunities for continuous education, training, and professional development serve as key motivators for health workers, contributing to improved service delivery and overall efficiency.
    • Constant Attrition: The attrition rate of skilled providers can be addressed through TCI’s advocacy efforts with key leadership to improve health worker motivation, retention, and performance. Ensuring equitable workforce distribution, providing supportive supervision, and offering opportunities for continuing education and professional development. These efforts help sustain motivation among skilled providers, ultimately reducing attrition.
    • Inadequate Staffing: Inadequate staffing levels compromise service delivery. An overwhelming workload can lead to low morale, fatigue, and moral distress, ultimately affecting the quality of patient care. This issue can be addressed through advocacy with key leadership for staff rationalization based on workload and the implementation of task-shifting strategies to ensure a more balanced distribution of responsibilities.

Key Resources

Explore More Interventions

Approach Content
Back to Program Area
Next Quiz
#printfriendly { font-family: Helvetica; font-size: 16px; } span.et_pb_fullwidth_header_subhead { font-size: 30px; font-weight: 600; font-family: helvetica; color: #252379; } #printfriendly h5 { color: #252379; font-size: 20px; font-weight: 700; } #printfriendly h3 { color: #252379; font-size: 24px; font-weight: 700; } #printfriendly h1, #printfriendly h2, #printfriendly h3, #printfriendly h4 #printfriendly h5{ color: #252379; } TCI U Menu