The cascade model

To efficiently reach more health providers, 50,000 Happy Birthdays used a cascade approach to deliver training. The cascade of multiple simultaneous trainings were implemented in a total of 872 rural and urban sites.

12,640

Training episodes in Ethiopia

11,638

Training episodes in Rwanda

4,246

Training episodes in Tanzania

ModuleMTFMTCH
BAB-C242782,669
PEE242952,648
HBB222872,732
ECEB231721,635
ECSB231721,635
Total1171,20411,319
MTF = Master trainer facilitator. MT= Master trainer. CH= Champion
ModuleMTFMTCH
BAB-C163332,111
PEE183281,842
HBB165061,699
ECEB165382,056
ECSB164821,661
Total822,1879,369
MTF = Master trainer facilitator. MT= Master trainer. CH= Champion
ModuleMTFMTCH
BAB-C341761,078
PEE34176808
HBB2666715
ECEB2665472
ECSB2665479
Total1465483,552
MTF = Master trainer facilitator. MT= Master trainer. CH= Champion

“(Before) trainings were structured in a way that only some staff in charge would attend training in the hotels. They would get certificates, but in the end, no one would get to know what those in charge have been trained in. But the cascade approach, it gets to everyone”.

Midwife trained during the project

Reach of the cascade HMS and HBS trainings

343 National Master Trainer Facilitators (MTF) were trained with the support of HMS and HBS international experts
3,896 Master Trainers were trained at a provincial level by MTFs
+20,000 champions: Health providers and students that received training in at least one module

Champions with good communication skills then became Peer Practice Coordinators . They motivated and mentored others attending the Low Dose, High Frequency practice sessions.

Champions demonstrated their improved competence and confidence to their peers. This influenced many more health providers

Many more beyond those trained in the project also adopted the evidence-based skills and respectful care practices taught in the HMS and HBS modules.

“The project has helped me a lot in my daily duty”

“I strongly remember a day when the training helped me save lives. While I was a mentor at Kiziguro district, I was able to identify signs of severe pre-eclampsia in two mothers. They had been in the hospital over 12 hours without being managed. I suggested to provide magnesium sulphate and anti-hypertensive medication, but the doctors were hesitant —this was not their usual practice and they feared harming the mothers or the babies. But I know what the safe dose is! We provided the medication and both mothers delivered soon after that. We saved two mothers and two babies that day.”

Seraphine, midwife at CHUK in Kigali, Rwanda.

Implementation sites

The project was implemented in various regions in Ethiopia, Rwanda and Tanzania, pinned in the map below.