Since it's development in 2002, the PROMPT course and it's underlying principles of local training with full involvement of the multi-professional team have been widely adopted in the UK and other countries across the world.

The maternal mortality rate in Zimbabwe had increased from 555 to 960 per 100,000 live births between 2006 and 2011. Furthermore a national review identified 47% of maternal deaths as avoidable.  PROMPT was first implemented in Zimbabwe at Mpilo Central Hospital, Bulawayo in 2011.  A visiting multi-professional team delivered a three day 'Train the Trainers (T3) programme to a small group of local staff, consisting of midwifery matrons, midwives and doctors.  The programme included a demonstration of the PROMPT course, training in adapting and delivering a local PROMPT course and finally, supporting the local staff in running their local training for their fellow colleagues.

In 2011 North Bristol NHS Trust (NBT) and Mpilo Central Hospital in Bulawayo, Zimbabwe, were linked through a Research Health Partnership funded by the UK Government organisation Tropical Health and Education Trust  (THET).  As part of this partnership a team of midwives, obstetricians, a paediatrician and anaesthetists from NBT and the Zimbabwe Health Training Support (ZHTS) travelled to Zimbabwe in November 2011 to run a PROMPT Train-The-Trainers (T3) programme which had been adapted for this setting.

The Zimbabwean team were provided with all the resources that were required to continue running the training, local staff introduced a board to provide an overview of patients on the labour ward.  Local staff also adapted a maternity early warning score chart and monitored its effectiveness with monthly post audits.  A maternity dashboard was developed and completed monthly by the Reproductive Health Officer to enable local monitoring of clinical outcomes. 

Within the first 12 months, 90% of staff working in the maternity unit had attended a PROMPT training day run within their hospital and facilitated by local staff.  The maternity dashboard allowed the staff to take responsibility for local outcomes and promoted a positive attitude towards improvements in patient care.  It also enabled the PROMPT trainers to be locally responsive and and focus training on where it was needed most. Since the introduction of PROMPT and its safety tools, the maternal mortality rate at Mpilo Central Hospital decreased by 34%.  In 2011 there were 67 maternal deaths and 9078 live births at Mpilo, by 2014 this had reduced to 48 maternal deaths with 9884 live births.

Since the visit, midwives and doctors at Mpilo have run 9 local PROMPT training courses at Mpilo with 203 members of staff at Mpilo trained; 88% of these staff had never previously attended any obstetric emergency training.  In addition to running the PROMPT training, staff from the maternity unit have made changes to their working environment including the introduction of a labour ward board, emergency boxes and Maternity Obstetric Early Warning Score (MOEWS) Charts.

In conjunction with the introduction of PROMPT training, staff at Mpilo are now able to monitor their clinical outcomes through a monthly maternity dashboard produced by the Reproductive Health Officer.  The introduction of PROMPT led to a 34% reduction in maternal mortality at Mpilo Hospital.

                                        

In 2015 the Tropical Health and Education Trust (THET) provided further funding for PMF and the Zimbabwe Catholic Bishops’ Conference to work as partners to implement a 2 year project replicating the success of Mpilo Central Hospital project by the dissemination of PROMPT in four more hospitals within Zimbabwe.  St Patricks Hospital, Hwange and St Lukes Hospital, Centenary District, commenced PROMPT training in March 2014 and June 2015 respectively.  Staff from Mpilo travelled to these distant units to help local staff establish their own training.  The success of the training in Zimbabwe has led to a programme of roll-out of PROMPT training to 56 health facilities managed by the Zimbabwe Catholic Bishops Conference. 

The key to success of this project has ben the partnership between clinicians in Zimbabwe (seven of whom have travelled to the UK on partnership visits), Zimbabwean diaspora within the UK and the UK PROMPT team based at North Bristol NHS Trust.  The enthusiasm and hard work of our Zimbabwean colleagues has enabled PROMPT training to be adapted into locally relevant and effective safety tools.

The Partnership would like to thank the Tropical Health and Education Trust (THET) and the Department for International Development (DfID) for their continuing support of this project.

2019

Dr Clare Shakespear has been invited to work as a Registrar at Mpilo Hospital for 2 years from February 2019. As well as contributing to the clinical and teaching work of the department, she would like to support the continuation of PROMPT training which has been so successful at Mpilo previously.  Clare found in March 2019 MEOWS charts were no longer in use due to lack of funding for printing.  In August 2019, with funding from The PROMPT Maternity Foundation MEOWS charts have been reintroduced to all wards (labour, antenatal and postnatal).  1000 charts have been used in the first month, and printing of a further 10,000 is in process.  Ongoing funding will be needed to ensure that they remain in use, as colour printing is beyond the resources of Mpilo Hospital.  

Clare is currently undertaking a review of the presence and use of safety tools, such as emergency boxes and guidelines to provide a current baseline for continued implementation of PROMPT in Mpilo Hospital.  Refreshing the contents of emergency boxes/protocols and ensuring they stay stocked is being addressed over the next 6 months.

In October 2019 Clare led the latest local PROMPT training with Mpilo Hospital's multi professional faculty team.