Onsite training of doctors, midwives and nurses in obstetric emergencies, Zimbabwe

Local settingMaternal mortality in Zimbabwe has increased from 555 to 960 per 100 000 live births from 2006 to 2011 and a national review of maternal deaths deemed that 47% of maternal deaths were avoidable. 7pilo Central Hospital is a public, tertiary referral hospital in Zimbabwe's second largest city, Bulawayo.Mpilo Central Hospital manages approximately 10 000 births per year and provides all of the services defined by the World Health Organization's (WHO's) comprehensive emergency obstetric care services.These include administering antibiotics, uterotonic drugs (oxytocin) and anticonvulsants (magnesium sulfate); manual removal of the placenta, removal of retained products following miscarriage or abortion, assisted vaginal delivery, caesarean sections, safe blood transfusion, basic neonatal resuscitation and provision of care to sick and lowbirth-weight newborns. 8Problem In Zimbabwe, many health facilities are not able to manage serious obstetric complications.Staff most commonly identified inadequate training as the greatest barrier to preventing avoidable maternal deaths.Approach We established an onsite obstetric emergencies training programme for maternity staff in the Mpilo Central Hospital.We trained 12 local staff to become trainers and provided them with the equipment and resources needed for the course.The trainers held one-day courses for 299 staff at the hospital.Local setting Maternal mortality in Zimbabwe has increased from 555 to 960 per 100 000 pregnant women from 2006 to 2011 and 47% of the deaths are believed to be avoidable.Most obstetric emergencies trainings are held off-site, away from the clinical area, for a limited number of staff.Relevant changes Following an in-hospital train-the-trainers course, 90% (138/153) of maternity staff were trained locally within the first year, with 299 hospital staff trained to date.Local system changes included: the introduction of a labour ward board, emergency boxes, colour-coded early warning observation charts and a maternity dashboard.In this hospital, these changes have been associated with a 34% reduction in hospital maternal mortality from 67 maternal deaths per 9078 births (0.74%) in 2011 compared with 48 maternal deaths per 9884 births (0.49%) in 2014.Lessons learnt Introducing obstetric emergencies training and tools was feasible onsite, improved clinical practice, was sustained by local staff and associated with improved clinical outcomes.Further work to study the implementation and effect of this intervention at scale is required.