Basic Emergency Obstetric Care Introduction to Training Guidelines, Session Plans & Role of
Trainers
March 07, 2011
Dr. Dinesh Baswal, Assistant Commissioner, Maternal Health Division,
Ministry of Health & Family Welfare201-D, Nirman Bhawan
New Delhi
What is EmOC ? The Signal functions…
• Parenteral antibiotics• Uterotonic drugs• Parenteral anticonvulsants• Manual removal of placenta• Removal of retained products• Assisted vaginal delivery• Neonatal resuscitation• Cesarean delivery• Blood transfusion
Basic EmO
C
Comprehensive Em
OC
Why EmOC?• Most of the obstetric complications can and should be
managed at PHCs.• Evidence from States indicates surge in the utilization of
institutional delivery services at 24 x 7 PHCs which are closer to the poor women in rural areas.
• Provision of services for management of obstetric complications at these facilities will prevent delays in treatment.
• Capacity strengthening of MOs posted at these facilities in diagnosing and managing obstetric complications is necessary.
• The BEmOC training will help them in the re-orientation of skills in diagnosing and managing obstetric complication.
Whats new?
• To improve skills of providers, training of ANMs/LHVs/SNs as SBA has already been in place but the MOs who are also the supervisors of this training need to be reoriented on the skills.
• A guideline on Pregnancy Care and Management of Common Obstetric Complications for Medical officers working at PHC and CHC level was prepared for this purpose in the year 2005.
• However, states could not implement it because of lack of training tools.
• A 10 days’ package for Medical officers is now in place but now the guidelines are also prepared as a facilitating tool.
Duration of Training
• Residential training of 10 days’ duration.• Out of 10 days, a minimum of 4-5 days should
be spent in the LR as 24 hours emergency duty.
• Follow the training schedule and session plan, as per the guidelines.
Eligibility Criteria for Trainers
• Faculty of Obstetrics/Gynaecology and Paediatrics from the medical colleges/district hospitals/identified training institutes shall be the main trainers.
• Nominated trainers must undergo orientation training.– Only willing personnel should be nominated as trainers.– The trainers need to spare extra time for this programme.– Not more than 50% of the faculty should be involved in the
training process at any point in time.• The other staff such as Senior Resident/Registrar, etc., can
supervise the trainee.• One trainer can take up maximum two trainees and the batch
size would be of 4 to 5 trainees each.
Training Site Requisites (Annex I)• Hospital attached to a Medical College which is recognized by MCI and
follows the norms of service delivery as laid down in “Guidelines for Pregnancy Care and Management of Common Obstetric Complications by Medical Officers”.
• Medical College which has sufficient strength of trainers and is imparting training to post graduate students in Obstetrics and Gynecology.
• Has proper infrastructure and its readiness as per Annexure 1 of the guidelines.
• Has a minimum delivery load of 150 every month and has facility for conducting C-section and other obstetrics related surgical interventions.
• Follows all protocols and practices, especially use of Partograph and active management of third stage of labour. (AMTSL).
• The clinical protocols such as AMTSL, Immediate management of PPH, Eclampsia and Essential Newborn Care etc. are displayed prominently in the labour room premises.
Annexure I : Checklist for Training Site Readiness
CHECKLISTS •Pre training site Readiness•Daily training site preparedness (for Theory & Practical Sessions including Equipments and Drugs)•Log book•Labor Room Roster
Training Methodology• Training methods should be interactive sessions, discussions, bed
side teaching, demonstration of skills, case studies, etc.• Flexible schedule with less stress on didactic lecture or class room
teaching, more priority to be given to clinical practice.• Trainer should limit himself/herself to impart knowledge/skills as
per the guidelines.• Training curriculum has been divided into 10 different sessions.• Theory lectures can be scheduled as per the convenience of trainer.
Emphasis should be on “Hands on” practice. • Sufficient teaching material, partographs, case sheets, stationery,
etc., are available.• Duty register of the trainees should be made available at suitable
places.• Trainer has to ensure that the quality of the training is maintained.
The Training Resource Pack
• GUIDELINES for Pregnancy Care and Management of Common Obstetric Complications by Medical Officers (Textbook)
• WORKBOOK for TRAINING of Medical Officers in Pregnancy Care and Management of Common Obstetric Complications
The Training Resource Pack
• TRAINEES' HANDBOOK for TRAINING of Medical Officers in Pregnancy Care and Management of Common Obstetric Complications
• TRAINERS' HANDBOOK for TRAINING of Medical Officers in Pregnancy Care and Management of Common Obstetric Complications
LR Roster
• A Labor Room Roster should be prepared by all the trainer’s at the training sites
• The Training site should be checked as per the day’s training site checklist a day in advance
• Trainer’s should ascertain that the trainees follow the Labor Room Roster
• The Labor Room Roster should be made available to the Site visiting teams from Centre or State
Expectations from the ToT Facilitators
• Handholding to:Ensure that the Trainers abide by the Guidelines and
Quality training is imparted through• Pre training – Ensuring that all protocols are in place,
Training Load calculation• Training – Pre-approval of Site Readiness through Site
inspection• Post Training – Regular Follow up of trainees in practicing
acquired skill setEnsuring that the expected outcomes are deliveredM & E field visits using the ChecklistsQuarterly M & E reports to be shared with the RCH
Officer at the State Level and GoI
Expectations from Master Trainers• All the Sessions are delivered as per the Session Plan and the
lectures are delivered using standardised presentations in the 21 hour schedule
• Trainees must learn to discharge/make referral of the patients during and after training as per the Annexure II and III of Trainee’s Workbook given in the Guidelines.
• The trainees should ensure privacy of the woman and respect her rights.
• Ensure Record Keeping by the Trainees which includes:– Record of all their activities in the Trainee’s Hand Book & Work
book and complete the specified number of activities as in Annexure II (Recommended Client Practice by Trainee).
– Attendance records have to be maintained, kept certified by the trainer/supervisor and kept with the trainer.
– A copy of the records related to certification will be maintained at the training institution as in Annexure IV (Record/ Assessment form for the Trainee).
Session Plan• Stick to the Session Plan• Presentations using the
Stantardized templates to be provided by GoI
• Maintain uniformity by following the “Guidelines for Pregnancy Care and Management of Common Obstetric Complications by Medical Officers”
• Trainees are to be posted at Ante natal OPD/LR/Post Natal ward or any other relevant place during the practice session (minimum of 6-8 hours per day)
Session Plan Contd…
• Maximum efforts should be undetaken to give hands on training to enhance skills rather than didactic lectures
• Session should be interactive• The trainers should be flexible
in following the suggested lecture schedule and it can be held at any point of time in the day depending on the situation
Annexure II : Recommended Client Practice by Trainee
• The trainers will ensure and monitor quality and practicing of these skills
• Trainee should keep a daily signed Cumulative Client Practice Record.
• This record will be utilized by Trainer for certification
• In case there is no client/patient on whom any of the above skills cannot be performed, then the trainer should use models or innovative approaches suggested to enable the trainees to perform the skills.
Annexure II : Referral Slip (Trainee’s Handbook)
Trainee must learn to discharge/make referral of the patients during and after training:
• Both these activities are very important and as such the MOs deputed for the training must practise these sincerely, so that they can replicate them at their health facility.
• Any patient being referred from one facility to another must have a referral slip, giving details as in Annexure II.
Annexure III : Discharge Slip (Trainee’s Handbook)
• All the patients admitted for pregnancy and delivery care, should be given a properly filled discharge slip, while getting discharged from health facility as in Annexure III.
• Skills’ assessment should be conducted as an integral component of performance during the posting and practicing of the skills.
• Assessment criteria are “Satisfactory/Unsatisfactory” as per the assessment of the trainer.
• During clinical sessions, trainer has to certify the findings on the case sheets filled by the trainee.
• In case the trainer is not available or is off duty during performance of skills suitable supervisor should be deputed for the same.
Assessment & Certification
Assessment & Certification …• The trainer must supervise at least 25% of the number
of cases mentioned in recommended client practice as in Annexure II.
• In situations where enough cases are not available, hands on practice should be given on mannequins/models.
• The trainees will be graded as satisfactory / needs re-orientation as per their overall performance. (> 70 % is satisfactory as per Annexure II)
• Those trainees certified as “unsatisfactory” will have to repeat 7 days of the training at the respective training institute before satisfactory completion of the training.
Training Session Assessment (Workbook)
• Page 1.1 of the Workbook
• The details of the Training Session should be recorded by the trainee
• The result of the Assessment need to be mentioned and signed by the trainers
Annexure IV : Record/ Assessment form for the Trainee (Pg 73 trainer’s)
• Trainee to be assessed on the 17 activities of the Recommended Client Practice by Trainee in given in the Trainer’s Handbook
• Observe the Trainee’s for all the 17 tasks stated in the this annexure and grade the same as satisfactory or unsatisfactory
• If a trainee is satisfactory for 70 % or more of the tasks i.e. a minimum of 12 tasks the trainee can be certified otherwise he/she will need reassessment and will have to repeat the course for 7 days at the institution at a later date
Expectations from MOs • The trainees should adhere to the schedule as per the session
plan• Trainees are expected to go through the topics of the sessions
given in “Guidelines for Pregnancy Care and Management of Common Obstetric Complications by Medical Officers”, beforehand and discuss these with the trainers during the sessions.
• Each trainee must fill in his/her observations in the case sheets (given in the workbook) during practice sessions, which would be certified on the spot by the trainer/supervisor.
• The trainees must work at least for 5 days in the LR for 24 hours emergency duties as per the roster.
Expected Outcomes of BEmOC Training
“Skilled EmOC personnel”
• Provide quality care and counseling to the woman during antenatal, intranatal and postpartum period.
• Identify danger signs during pregnancy, delivery and postpartum period along with the danger signs in the newborn and provide supportive care prior to referral.
• Monitor labour using partograph.• Practice active management of third stage of labour.• Provide step wise essential newborn care to all the new borns and new
born resuscitation, if required.• Make referral of complicated cases after initial management and
stabilization of the patient.
Annexure 3Trainers’ and Trainees’ Feedback Form
Trainer’s and trainee’s feedback should be recorded and provided to the training teams and Centre for continuous improvement of the BEmOC Training
Way Forward for NIHFW
• Ensure development of National Trainer’s Pool to meet shortcomings of Trainers in the States
• States which have surplus Trainer’s pool can be identified by NIHFW and these trainers can be resourced for deficient States
• NIHFW should keep track of the trainings and inform the GoI of the trainings being rolled out the State and District level a week in advance so that arrangements for on-site visit of the training can be planned.
• NIHFW needs to continuously assess the need of the Master Trainers for each State and need to build the pool of trainers in the State
Way forward for Trainers• RCH Nodal Officer should liaison with the Medical College for smooth
conduction of quality transformative training• RCH Nodal Officer will also keep a database of Master Trainers and
continuously get feedback from them• Rational Deployment of Trained Personnel in the Priority Facilities viz. 24 x 7
PHCs• Feedback from trainer / trainees for continuous improvement of training
(Annexure III: Trainer’s & Trainees feedback form)• Assisted Delivery equipments to be available at the facilities at the identified
institutions• Training has to be rolled out within 3 months to minimize inherent losses• The Training Plan and list of trained MOs should be shared on an ongoing
basis with the Maternal Health Division of the GoI• Monitor trainees for practicing skills after the training• Training Plan for trainer’s Need to identify those who are practicing and those
not practicing• Of one batch how many are certified, training to know wastage factor and
know whether right candidates are identified
Hoping for a Successful Endeavor…
Thank you !
