Piloting of a modular competency-based training to improve maternal and newborn health in Nepal: a mixed-methods study

BACKGROUND: Despite increased facility-based childbirth in Nepal, stagnant neonatal and high maternal mortality highlight a critical 'know-do' gap in care quality. To address this, a modular, competency-based learning resource package (LRP) was developed for maternal and newborn health providers. METHODS: A mixed-methods exploratory pilot study involved curriculum alignment with international standards, multidisciplinary co-design and a single-group pre-post evaluation among 24 nursing professionals in Gandaki Province. Feasibility and acceptability were evaluated utilizing objective structured clinical examinations (OSCEs) and qualitative interviews. RESULTS: Non-parametric analyses revealed significant educational gains. Median knowledge scores increased from 64.0 to 88.0. Statistically significant median improvements (p<0.001) were documented across all OSCE clinical domains: antenatal care (30.0 to 92.1), postnatal care (53.8 to 90.4), infection prevention (31.8 to 90.0) and respectful maternity care (30.0 to 92.9). Qualitative data indicated high acceptability; however, heavy clinical workloads and linguistic diversity constrained programmatic sustainability. CONCLUSIONS: The LRP is a feasible intervention to bridge clinical competency gaps. Definitive national scale-up requires larger controlled trials assessing patient-level outcomes along with essential systemic investments in supply chains, healthcare infrastructure and continuous post-training mentorship.