The gap between what healthcare workers learned in training school and what they face in understaffed, under-resourced health facilities can be measured in more than just skills, it’s measured in lives.
In Kano State, that gap has been particularly stark. Midwives and nurses managing deliveries often work alone, handling complications they may have only read about in textbooks years ago. Equipment breaks down. Supplies run out. Refresher training opportunities are rare. And women continue to die from preventable causes during childbirth.
But December 2025 marked a turning point.
Understanding The Gap
Northern Nigeria faces some of the country’s most severe maternal health challenges. The reasons are complex and interwoven: limited access to quality healthcare, shortage of skilled birth attendants, inadequate medical supplies, and systemic gaps in healthcare worker training and support.
For many healthcare workers in Kano State’s primary health facilities, their last comprehensive training on emergency obstetric care may have been years, sometimes decades ago. Medical protocols evolve. New evidence-based interventions emerge. But without regular refresher training, frontline workers remain unaware of these advances.
The result? Healthcare workers doing their best with outdated knowledge, improvised techniques, and eroding confidence when faced with obstetric emergencies.
A Comprehensive Response
The 13-day NPHCDA Refresher Training, delivered in December 2025 under the Advancing Emergency and Routine Immunization (AEARI) Programme, was designed to address these gaps systematically. WCAHealth Options provided technical facilitation, working alongside NPHCDA, the Kano State Primary Health Care Management Board (KNSPHCMB), TAConnect/Gates Foundation, WHO, and the Global Gas and Health Network.
The training curriculum covered the full spectrum of Skilled Birth Attendance competencies:
- Antenatal care essentials: Identifying high-risk pregnancies early
- Safe delivery practices: Evidence-based techniques for normal and assisted deliveries
- Emergency obstetric care: Managing hemorrhage, eclampsia, sepsis, and obstructed labor
- Postpartum care: Recognizing and responding to complications in the critical hours after birth
- Newborn resuscitation: Life-saving interventions in the first minutes of life
But coverage alone wasn’t enough. The training needed to change how healthcare workers think and act in crisis moments.
The Power of Practice
One of the most significant lessons from the Kano training was the effectiveness of simulation-based learning. Rather than relying solely on lectures and demonstrations, participants spent substantial time practicing on anatomical models and working through realistic emergency scenarios.
This approach addressed a critical insight: knowing what to do is different from being able to do it under pressure.
Participants practiced measuring blood loss using calibrated drapes, simple, low-cost tools that replace subjective estimation with objective measurement. They rehearsed the E-MOTIVE bundle, a WHO-endorsed intervention package that systematically addresses postpartum hemorrhage. They worked through scenarios involving multiple simultaneous complications, learning to prioritize and delegate under stress.
The repetition built confidence. Healthcare workers who initially hesitated when faced with a simulated emergency became more decisive, more systematic, and more effective with each practice session.
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Adapting Global Standards to Local Realities
Another crucial lesson involved contextualizing international best practices for the realities of primary health facilities in northern Nigeria.
Global guidelines often assume certain baseline resources: reliable electricity, consistent supply chains, functional equipment, and backup support systems. Many facilities in Kano lack some or all of these. Training that doesn’t acknowledge these constraints risks being irrelevant.
WCAHealth’s technical facilitation focused on practical adaptations:
- How to implement the E-MOTIVE bundle when certain medications are temporarily unavailable
- Manual alternatives when electronic monitoring equipment fails
- Communication strategies when referral systems are weak
- Creative problem-solving when working with limited supplies
This wasn’t about lowering standards, it was about maintaining high-quality care within real-world constraints while simultaneously advocating for systemic improvements.
Beyond Individual Skills: System Strengthening
The training revealed that bridging skill gaps requires more than updating individual competencies. It requires addressing systemic issues that prevent skilled healthcare workers from performing effectively.
Several system-level challenges emerged during the training discussions:
Supply chain inconsistencies: Healthcare workers can’t use calibrated drapes if they’re not consistently available at facilities. They can’t administer uterotonics for postpartum hemorrhage if stock-outs are frequent.
Inadequate supportive supervision: Without regular mentorship and quality assurance visits, trained healthcare workers may gradually revert to old practices or lose confidence in applying new techniques.
Documentation and data systems: Poor record-keeping makes it difficult to track outcomes, learn from complications, or demonstrate the impact of improved practices.
Weak referral systems: Even the most skilled birth attendant needs reliable emergency referral systems for complications beyond primary care capacity.
Recognizing these challenges, WCAHealth Options and KNSPHCMB are establishing post-training support mechanisms: mentorship programs, regular supervisory visits, and supply chain monitoring to ensure that improved skills translate into sustained practice change.
The Multiplier Effect
Perhaps the most promising lesson from Kano is the potential for trained healthcare workers to become change agents within their facilities and communities.
The training model deliberately included healthcare workers from the same facilities and local government areas, creating peer support networks. These cohorts can reinforce learning, share problem-solving strategies, and collectively advocate for needed improvements in their work environments.
Additionally, participants received training-of-trainers components, equipping them to mentor colleagues and conduct mini-training sessions at their facilities. This creates a multiplier effect, the impact of 13 days of intensive training extends far beyond the immediate participants.
Measuring What Matters
WCAHealth Options and partners are tracking several indicators to assess whether the training achieves its ultimate goal: reducing maternal mortality and morbidity.
Short-term indicators include:
- Adoption rates of calibrated drapes and E-MOTIVE protocols across facilities
- Healthcare worker confidence scores in managing obstetric emergencies
- Quality of documentation and adverse event reporting
Medium-term indicators will track:
- Changes in facility-level maternal mortality and near-miss cases
- Referral patterns and outcomes
- Community perceptions of quality of care
The real test will be whether, six months from now, the healthcare workers who participated in this training are still applying what they learned and whether women and newborns are surviving complications that might previously have been fatal.
Replicating Success
The Kano training model offers important lessons for workforce strengthening efforts across northern Nigeria and similar contexts:
Invest in hands-on practice: Simulation-based training builds competence and confidence in ways that lectures cannot.
Contextualize globally: International best practices must be adapted to local resource realities while maintaining quality standards.
Think systemically: Individual skill development must be accompanied by health system strengthening, supply chains, supervision, referral systems, and data management.
Build local ownership: Partnering with state health management boards and involving local healthcare workers in training design ensures sustainability.
Plan for follow-up: Training is a starting point, not an endpoint. Ongoing mentorship and supportive supervision are essential.
Measure impact rigorously: Track not just training completion but changes in practice and, ultimately, health outcomes.
The Road Ahead
The 13-day training in Kano represents significant progress, but it’s one step in a longer journey. Bridging skill gaps in northern Nigeria will require sustained investment, political commitment, and continued innovation in training approaches.
WCAHealth Options remains committed to this work, not just delivering training, but building the systems and partnerships necessary for lasting change. The organization’s Nigerian leadership brings deep understanding of local contexts and the relationships needed to navigate complex health system challenges.
As trained healthcare workers return to their facilities across Kano State, they carry new skills, renewed confidence, and practical tools. They also carry something less tangible but equally important: evidence that change is possible, that they are supported, and that their work matters.
For the women who will arrive at these facilities in labor in the coming months and years, these changes could mean the difference between life and death. And that’s what bridging the skill gap is ultimately about, not just competence frameworks and training curricula, but mothers going home with their babies, families staying intact, and communities thriving.
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