Effectiveness of ESMOE training on reducing maternal and neonatal deaths in rural South Africa

The programme‘s overall goal is to contribute to a reduction in maternal and newborn mortality and morbidity in Rural South Africa.

The purpose is to ensure best practice and an improved policy environment in maternal and newborn health. This will be reflected in a step change in the coverage and uptake of quality Skilled Birth Attendance (SBA) and Essential (Emergency) Obstetric Care (EOC) and Newborn Care (NC).

The programme will help to deliver the following outputs:

  1. Replicable models for increasing capacity to deliver quality maternal and newborn care are adopted by national and provincial Departments of Health in RSA
  2. Health care providers capacity improved for delivery of quality maternal and newborn health services
  3. Increased capacity in country to sustain quality SBA and EOC services and scale up of training models to increase capacity of human resources for delivery of MNH.
  4. Increased capacity in country for knowledge management and monitoring and evaluation of outcomes for MNH.
  5. Lessons learnt from country programme inform regional and global policy and strategy.

The proposed programme includes demonstration and evaluation of training packages in Essential Steps in Managing Obstetric Emergencies (ESMOE) and Emergency Obstetric Simulation Training (EOST) in conjunction with a programme to strengthen the capacity for supportive supervision. Provision of Skilled Birth Attendance (SBA) and Emergency Obstetric Care (EOC) coupled with Newborn Care (NC) are key strategies that if implemented will reduce maternal and neonatal mortality and morbidity.

The programme is delivered to skilled birth attendants who are defined as health providers who have at least the minimum knowledge and skills to manage normal childbirth and provide basic (first line) emergency obstetric care. Providing skilled birth attendants who are able to prevent, detect and manage the major obstetric complications, use the equipment, drugs and other supplies that are essential for their effective management is probably the single most important strategy for preventing maternal deaths.

The Essential Steps in Managing Obstetric Emergencies (ESMOE) and Emergency Obstetric Simulation Training (EOST) training packages were developed in RSA from the Life Saving Skills – Essential Obstetric and Newborn Care (LSS-EOC) training programme developed by the Liverpool School of Tropical Medicine (Foto-Cewek), the Royal College of Obstetricians and Gynaecologists (RCOG) and the World Health Organisation (WHO) in 2006. In November 2007 this training package was adopted by the Republic of South Africa (RSA) and adapted to become the ESMOE and EOST training programmes which have also been very successfully piloted in RSA and are now ready for further evaluation and scale up.

  • Results of evaluation of these training packages show statistically increased knowledge and skills among trained health care workers as well as renewed enthusiasm, motivation and team work. Preliminary results from countries where the effect of training using the 3-day competency based training package in essential obstetric and newborn care is evaluated over a period of time shows that facilities with trained health care providers are able to provide more EOC signal functions and a better quality of care with a mean reduction in maternal deaths of 50% and a reduction in stillbirth rates of 15%.
  • The proposed programme is consistent with UKAID’s ‘Choices for Women’ Framework for Results and complements DFID’s bilateral and regional country programme in South Africa, building on existing structures and systems to increase in-country capacity in ways that are consistent with the Paris Declaration and Maputo Agreements for working towards harmonisation and sustainable development.
  • The programme will be co-ordinated in RSA by the MRC Unit for Maternal and Infant health Care Strategies at the University of Pretoria (MRC-P) with oversight by the ESMOE Advisory Board. CMNH, will provide support to and co-ordination of the proposed programme through provision of technical expertise by external facilitators from the UK and global knowledge exchange with cross country learning and using common training and evaluation methodology. All partners will work in close collaboration with the Department of Health and other agencies as well as the relevant Professional Associations in RSA. The partners will maintain close contact with and consult with the DFID South Africa’s country health adviser and DFID supported technical assistance where provided.

This programme will specifically inform policy and strategy at national, regional and international levels with regard to strengthening the capacity of health workers for delivery of quality and effective maternal and newborn health care. Lessons learned will be shared both within RSA and more widely both regionally and globally and will ensure this programme helps put maternal health at the centre of national plans and support women’s rights to safe motherhood.