Abstract:
BACKGROUND. Poor emergency obstetric care has been shown by national confidential enquiries into maternal deaths to contribute to a
number of maternal deaths in South Africa.
OBJECTIVES. To assess whether a structured training course can improve knowledge and skills and whether this can influence the capacity of
a healthcare facility to provide basic and comprehensive emergency obstetric care signal functions.
METHODS. A baseline survey was conducted to assess the seven basic emergency obstetric and neonatal care signal functions in 51 community
health centres (CHCs) and the nine comprehensive emergency care signal functions in 62 district hospitals (DHs). A reassessment
was
conducted 1 year after saturation training had been provided in each district. The delegates were trained using a structured training
programme (Essential Steps in Managing Obstetric Emergencies, ESMOE) and their knowledge and skills were tested before and after the
training. Saturation training was considered to have been achieved once 80% of the healthcare professionals involved in maternity care had
been trained.
RESULTS. There was a significant improvement in the knowledge and skills of doctors, namely by 16.8% and 32.8%, respectively, of advanced
midwives by 13.7% and 29.0%, and of professional nurses with midwifery by 16.1% and 31.2%. The seven basic emergency care functions
improved from 60.8% to 67.8% in the CHCs and from 90.7% to 92.5% in the DHs before and after training. If the two signal functions
that are not within the scope of practice of professional nurses with midwifery are excluded (viz. assisted delivery and manual vacuum
aspiration), the functionality of CHCs increased from 85.1% to 94.9%.
CONCLUSIONS. The ESMOE training programme improved knowledge and skills, but there was a modest improvement in the functionality of
the facilities. Improvement in functionality requires changes in the structure of the health system, including changing the scope of practice
of professional nurses with midwifery and employing more advanced midwives in CHCs.
