International training programs for maternity hospitals staff based at BRICS countries: the Russian experience

Introduction

The global agenda for improving maternal and under-five survival is reflected in Sustainable Development Goals 3.1 and 3.2, which aims to reduce the global maternal mortality ratio to fewer than 70 cases per 100,000 live births¹, and the neonatal mortality rate to no more than 12 cases per 1,000 live births² by 2030.

More than 90% of maternal deaths occur in low- and lower-middle-income countries; sub-Saharan Africa and South Asia together account for approximately 87% of the global maternal mortality burden³. Maternal and neonatal outcomes also vary considerably within countries because of differences in access to medical care, availability of trained personnel, and the general preparedness of maternity hospitals, workforce capacity, and referral pathways^4,5.

BRICS members and partner countries represent different demographic, socioeconomic, and healthcare contexts. Therefore, maternal and neonatal health indicators, as well as the needs for professional training, may differ considerably across these countries. The organization of maternity care, referral systems, availability of specialized hospitals, and access to emergency obstetric and neonatal care are also not similar [1][2].

Maternal and neonatal mortality in the BRICS countries is not only relevant to medicine, but also goes right to the heart of the question of how healthcare is organized. Issues such as obstetric hemorrhage, hypertensive disorders, sepsis, infectious crises, prematurity, low birth weight, congenital anomalies are associated with delays in referral, limitations in antenatal and intrapartum care, and inadequate facility readiness. If high-quality care is provided in a timely manner and by highly trained obstetric and neonatal experts, then a considerable proportion of maternal and neonatal deaths can be potentially prevented [3].

Simulation-based and competency-based care can improve clinical knowledge, practical skills, teamwork, as well as the management of obstetric and neonatal emergencies. These approaches are especially important in situations that require rapid and coordinated actions from obstetricians, anesthesiologists, neonatologists, midwives, and nurses. However, the evidence on how long-term competencies are retained, how changes in routine clinical practice are carried out and how they relate to the sustained effects on maternal and neonatal outcomes is still patchy [4–7].

International maternal and neonatal training initiatives have greatly expanded during the last decades. Nevertheless, published information on long-term multilingual programs involving healthcare professionals from BRICS members and partner countries remains limited. There is also limited information about the geographical coverage of such programs, the professional characteristics of participants, and the results of recent programs have not yet been evaluated. This makes it difficult to assess how feasible these programs are, and whether they can be implemented in different healthcare settings.

Russia has developed a regionalized model of perinatal care that includes risk-based referral of pregnant women, concentration of high-risk deliveries in higher-level facilities, and continuous professional education of maternity-care personnel [8]. Certain elements of this experience were included in the International Training Program developed at the Kulakov National Medical Research Center. The Program was designed as a multidisciplinary educational initiative for healthcare professionals from countries with different healthcare systems and different levels of available resources.

This study aimed to describe the structure, geographical reach, participant characteristics, and the outcomes of the International Training Program implemented by the Kulakov National Medical Research Center between 2012 and 2025, with particular attention being paid to healthcare professionals from BRICS member and partner countries.

Materials and methods

Study design and setting

We conducted a retrospective descriptive study based on aggregated administrative data from the Russian International Project “Ways to reduce maternal and infant mortality.” The study covered training activities carried out between 2012 and 2025 at the Kulakov National Medical Research Center and, where applicable, at healthcare facilities in participating countries.

The present analysis included aggregated data on records relating to healthcare professionals from 11 countries: Uzbekistan, Nicaragua, Cuba, Kazakhstan, Thailand, Ethiopia, Indonesia, Uganda, India, the United Arab Emirates, and Brazil. The available reports covered activities conducted during 11 calendar years: 2012–2015, 2017–2019, and 2022–2025.

Data sources and variables

The data sources included annual program reports and consolidated administrative tables prepared by the organizing institution. The study was based exclusively on aggregated and de-identified administrative reports. No individual-level personal data were accessed by the investigators. The aggregated reports contained information on 1,055 participant records from the selected countries. The available aggregated administrative data did not allow repeated participation by the same healthcare professional. Nor could they be identified or excluded.

The extracted aggregated indicators included demographic characteristics, country and year of participation, professional background, work experience, academic qualifications, management position, training format, and participant feedback. Post-training feedback was routinely collected as part of the procedures. Only aggregated feedback results were available for the present study.

Statistical analysis

The analysis used descriptive indicators reported in the consolidated administrative reports. Categorical data were reported as absolute numbers and percentages, while continuous variables were presented as means with standard deviations, medians, and ranges, where available. No inferential statistical analyses were performed. Individual-level statistics could not be independently recalculated because participant-level data were unavailable.

Results

Overview of Project “Ways to reduce maternal and infant mortality”

In 2011, as a part of the Muskoka Initiative of G8 Countries, Russia launched an initiative to reduce maternal and child mortality by training health workers in maternal and child health. With the support of the Government of the Russian Federation, the Ministry of Finance, the Ministry of Foreign Affairs, and the Ministry of Health, the International Project “Ways to reduce maternal and infant mortality” was started at the Simulation and Training Center of the Kulakov National Medical Research Center.

The Project aimed to identify gaps in the training of healthcare workers; introduce simulation-based educational technologies using equipment of varying complexity, including high-fidelity computerized mannequins; develop practice-oriented training models; and support the training of those working in simulation and training centers. The overall characteristics of the Project are presented in Table 1.

Training program

The Project’s core component is a Training Program consisting of 6 specialty-specific tracks and lasting for 72–80 (since 2024) hours (within 10 working days). The official languages are Russian, English, Spanish, and French, which allowed the Program to be delivered to specialists from the CIS, Latin America, Francophone Africa, and Asia.

The Program was intended for physicians and nursing professionals working in obstetrics, gynecology, neonatology, anesthesiology and intensive care (Table 2). The target audience also included heads of healthcare facilities and clinical departments, chief physicians, and specialists involved in the organization and management of maternity and newborn care.

In addition to core clinical topics, each track integrates cross-cutting modules on infection prevention, quality management and patient safety, as well as training in professional communication, teamwork, burnout prevention and conflict management.

Training formats

The Program comprised lectures and seminars, accounting for approximately 60% of the curriculum; hands-on training, accounting for approximately 30%; and mixed formats, including seminar-based training, clinical department visits, and case discussions, accounting for approximately 10%. Within these educational formats, simulation-based activities using mannequins and other simulation equipment accounted for at least 30% of each track and more than 40% of the obstetrics and neonatology tracks.

The Program’s simulation-based training included repeated skills practice, team-based multidisciplinary scenarios, and structured debriefing. Multidisciplinary team training involved an obstetrician, anesthesiologist, neonatologist, and a nurse or a midwife. These sessions used time-critical clinical scenarios to simulate coordinated emergency care.

The multidisciplinary scenarios focused on coordinated team responses to severe obstetric hemorrhage, hypertensive disorders of pregnancy (preeclampsia/eclampsia), sepsis, and neonatal asphyxia. Case-based learning was used to consolidate theoretical knowledge and develop clinical thinking. The anesthesiology and intensive care track included scenarios involving pulmonary embolism and amniotic fluid embolism – time-limited emergencies where team coordination is critical. The neonatology track includes training in whole-body therapeutic hypothermia, continuous positive airway pressure (CPAP), and mechanical ventilation for preterm newborns.

Curriculum content informed by international guidance

The Training Program curriculum covers all key components of intranatal and postnatal care regulated by the World Health Organization Labor Care Guide (2020): management of normal labor, basic labor protocol, fetal monitoring, normal and pathological biomechanism of labor, tactics for presentation anomalies, management of the third stage of labor and prevention of postpartum hemorrhage.

The neonatology track includes a comprehensive neonatal resuscitation module, compliant with current International Liaison Committee on Resuscitation Neonatal Life Support 2025 guidelines and Neonatal Resuscitation Program protocols: resuscitation algorithm for term and preterm newborns, mechanical lung ventilation, CPAP, FAST-protocol, and controlled hypothermia [14]. The presence of a separate training course “Full body hypothermia” reflects commitment to current standards for the treatment of hypoxic-ischemic encephalopathy.

Teaching staff

The Training Program was given by 110 lecturers and trainers who participated in at least one training activity between 2012 and 2025, with organizational and technical support from the Centre’s staff. The overall staff includes academicians of the Russian Academy of Sciences, professors, Doctor of Science (Med.) and PhD in medicine, as well as head specialists of the Ministry of Health of Russia. The teaching faculty practice in the main professional areas included in the Program: obstetrics and gynecology, neonatology and pediatrics, anesthesiology and resuscitation, and obstetric and neonatal nursing.

The majority of lecturers are the authors of the National Clinical Guidelines. Therefore, they teach not only academic knowledge, but also the regulatory standards of care applied in the Russian system of medical care. The teaching staff also included heads of clinical departments and practicing clinicians from the Kulakov National Medical Research Center.

Program coverage and participant characteristics in the 11 selected countries, 2012–2025

The present BRICS-focused analysis included aggregated data from 11 selected countries: Uzbekistan, Nicaragua, Cuba, Kazakhstan, Thailand, Ethiopia, Indonesia, Uganda, India, the United Arab Emirates, and Brazil.

The analysis was based on aggregated administrative reports from the Russian International Project “Ways to reduce maternal and infant mortality” and included 1,055 participants from these countries. The available reports covered 11 annual reporting periods: 2012–2015, 2017–2019, and 2022–2025. Training activities were conducted at the Kulakov Center and in the hospitals of the participating countries.

The largest proportion of participants came from the Commonwealth of Independent States (CIS) – 64.5%. They were followed by Southeast Asia (18.4%) and Latin America (12.1%). Uzbekistan had the largest number of participants (n = 613). The highest annual numbers of participants were recorded in 2022 and 2025. From 2012 to 2019, The Program was predominantly Eurasian in its geographical coverage (CIS, Southeast Asia and Africa). Since 2023 Latin American countries have become more actively involved in the Program, initially through the participation of healthcare professionals from Cuba and, from 2025, from Brazil. Increased participation from Indonesia, Thailand, Uganda, and United Arab Emirates was also recorded in 2025. The annual distribution of participants by geographical region is presented in Figure 1.

The total number of participants for the period 2022–2025 was higher than for 2012–2019. It indicates that the Program is expanding substantially in terms of coverage. On-site training in the participating countries made it possible to involve healthcare professionals without any prolonged interruptions to their clinical work. The largest numbers of on-site training activities were recorded in Uzbekistan, Cuba, Nicaragua and Indonesia.

Demographic characteristics and professional qualification structure

Women comprised 66.3% of all participants (699 people). The age range of participants ranged from 22 to 75 years; the mean age was 43.4 ± 9.8 years and the median age was 43 years. Almost 90% of the participants were aged 30–59 years (88.3%). Summary demographic data are presented in Figure 2.

The distribution of participants according to their primary medical specialty is presented in Table 3.

Aggregated pre-training questionnaires identified four principal areas in which participants reported a need for additional capacity building:

• practical management of obstetric emergencies, particularly postpartum hemorrhage and eclampsia;
• availability of adequately trained neonatologists;
• standardization of clinical protocols;
• healthcare leadership and management.

The combined proportion of the three core specialties – obstetricians-gynecologists, neonatologists and pediatricians, and anesthesiologists and intensive care physicians – accounted for 91.2% of all participants (n = 962).

Professional experience and participants’ feedback

The mean duration of professional practice among participants was 18.2 ± 10.6 years (median, 17 years; range, 1–54 years). The distribution by professional experience duration was as follows: <5 years – 8.1%; 5–9 years – 13.9%; 10–19 years – 28.6%; 20–29 years – 24.6%; ≥30 years – 15.7%; and not reported – 8.9%. Thus, more than half of the participants had 10–29 years of professional practice (53.2%). Overall, 13.6% of participants (n = 143) held an academic degree or academic title, including 72 PhD (Med.) (6.8%), 49 Dr. of Sci. (Med.) (4.6%), 17 professors (1.6%), and 5 academicians (0.5%). Summary data on academic degrees and work experience are presented in Figure 3.

Training in healthcare management for leaders and heads of medical departments and facilities was provided to 168 participants. The largest groups came from Uzbekistan (n = 63), Cuba (n = 37), and Nicaragua (n = 14).

According to the aggregated post-training feedback, participants generally evaluated the Program positively, with mean scores for the assessed components ranging from 4.55 to 5.00 on a five-point scale. Participants reported that the training provided new knowledge and introduced contemporary evidence-based approaches. They also highlighted the practical relevance of the training, and the organization of hands-on simulation sessions. The trainees also reported a better understanding of multidisciplinary teamwork and clinical communication, as well as greater confidence in applying the acquired knowledge and skills in routine practice. International professional exchange was evaluated positively, and the specialists expressed interest in continuing the Program, expanding access to training, and increasing its duration. Overall, the feedback indicated that participants valued both the clinical content and the practice-oriented format of the Program.

However, because only aggregated feedback data were available, responses could not be compared by country, professional specialty, or training format.

Discussion

This study provides a descriptive assessment of a long-term international training program in maternal and newborn care involving healthcare professionals from 11 BRICS member and partner countries. The Program combined multilingual delivery, simulation-based learning, multidisciplinary content, and both center-based and on-site training. Most participant records were related to specialists directly involved in obstetric and neonatal care, and immediate post-training feedback was consistently positive. The long-term effects of the Program on professional competence, clinical practice, or maternal and neonatal outcomes are to be in the scope of further studies.

The concentration of participant records in 2022–2025 indicates a substantial expansion of the documented Program coverage, accompanied by broader participation from Latin America, Southeast Asia, Africa, and the Middle East. On-site training may have facilitated access by reducing the need for prolonged absence from clinical duties and international travel. Nevertheless, the trend for growing demand needs to be confirmed for a longer uninterrupted period along with the assessment of organizational and financial influence factors.

The professional composition of participants was consistent with the multidisciplinary character of maternity and newborn care. Obstetricians-gynecologists, neonatologists and pediatricians, and anesthesiology and intensive care specialists accounted for most records. The joint training of these professional groups is relevant because obstetric and neonatal emergencies require rapid coordination and clearly defined team roles [9]. At the same time, nurses and midwives represented a relatively small proportion of the analyzed sample, while their central role in monitoring, infection prevention, newborn care, and early recognition of clinical deterioration [10] makes them a target audience for training programs; this should be taken into account while forming the groups for future training sessions.

The Program also included experienced clinicians, heads of departments, healthcare managers, and specialists. Their involvement may support local training, revision of institutional protocols, and quality-improvement activities [11]. Further studies are needed to assess how the participants subsequently provided local training or introduced changes in clinical or organizational practice.

Participants generally rated the Program positively, with mean scores ranging from 4.55 to 5.00 on a five-point scale. Simulation sessions, practical relevance, contemporary clinical content, teamwork, and professional exchange were among the elements valued by participants. Immediate self-reported satisfaction and confidence need to be further confirmed by improved knowledge, practical skills, or clinical performance [12].

The Program shares several features with established initiatives in emergency obstetric and newborn care, including simulation-based training, multidisciplinary scenarios, competency-oriented education, and case discussion [6][9][13]. Its principal organizational characteristics include a 10-day duration, six specialty-specific tracks, four teaching languages, and a combination of center-based and on-site delivery.

Such a well designed, comprehensive, and high-tech course has the potential to improve still further by complementing it with valuable components from other international programs; for example, “Helping mothers survive” uses short workplace-based sessions repeated at regular intervals [14], while “Making it happen” incorporates master-trainer development, clinical audit, quality improvement, and multilevel evaluation⁶.

BRICS members and partner countries differ in the organization of maternity services, referral systems, professional roles, resources, and access to specialized care [1]. The implementation of the Program across these settings demonstrates its broad geographical applicability, although the extent of local curriculum adaptation was not assessed. Its multinational format may have provided opportunities for professional exchange and comparison of clinical and organizational practices between countries.

The principal contribution of this study is informative and organizational rather than clinical. It presents the structure, geographical coverage, participant characteristics, delivery formats, and outcomes of a Russian international educational initiative implemented over the period of more than a decade. Published evidence on long-term multilingual maternal and newborn training programs involving BRICS countries and their partners remains limited and needs to be supplemented with further studies.

This study was based on retrospective aggregated administrative reports; the detailed comparisons by country, profession, training track, language, or participant characteristics could be helpful to improve the program still further and to target the most demanding audiences.

Another limitation of the study is that the reports were available for 11 calendar years rather than continuously throughout 2012–2025. In addition, the Program changed over time in its duration, content, geographical coverage, and delivery formats, but the effects of these changes could not be evaluated separately. The analysis also included 11 BRICS members and partner countries with high CIS representativity, varying in country and year of participation, demographic and professional characteristics, training format, and post-training feedback. This variability also limited to some extent how one should generalize about the findings and whether the findings can be extrapolated to the audience of the wider Project involving 52 countries.

Further development of the Program will obviously benefit from a structured evaluation framework with standardized pre- and post-training knowledge tests, simulation-based competency checklists, and follow-up assessments after 6–12 months. Evaluation should also examine skill retention, local training activities, implementation of clinical protocols, and participation in quality-improvement projects. Post-training mentoring, remote case discussions, refresher simulation sessions, and training-of-trainers activities could support the application of acquired knowledge.

Conclusion

The International Training Program implemented by the Kulakov National Medical Research Center provided a long-term, multilingual framework for practice-oriented education in maternal and newborn care. The data analyzed documented its multidisciplinary structure, geographical coverage, combined center-based and on-site delivery, and positive immediate feedback from healthcare professionals in 11 BRICS members and partner countries.

These findings support the feasibility and acceptability of the Program as a platform for international cooperation in healthcare professional education. However, the available administrative and self-reported data need to be supported by the progress in clinical competence, routine practice, or maternal and newborn outcomes. Further evaluation should include standardized competency assessment, post-training follow-up, and prospective analysis of changes in clinical and organizational practice.