Creating a Sustainable ObGyn Residency in a Resource-Limited Country Improves Maternal Health Outcomes

Abstract

BACKGROUND: The 2013 maternal mortality ratio (MMR) in Guyana was 250/100,000 live births according to the WHO, compared to a regional average of 68. Inadequate quality of care, shortage of skilled health care professionals, and systemic limitations are contributing factors. METHODS: In 2012 University Hospitals/Case Medical Center (UHCMC), Georgetown Public Hospital Corporation (GPHC) and University of Guyana collaborated to develop a 4-year ObGyn training program using curriculum formalized at UHCMC, modified to suit local needs. A multi-academic institutional partnership allowed international faculty involvement in training Guyana's first ObGyn residents (MDG-8). Maternal morbidity and mortality outcomes (MDG-5) were prospectively maintained, analyzed, and compared to rates prior to program implementation. RESULTS: Twenty-three residents were trained and five residents completed the program in 2016. Full-time staff are present in Guyana, and 52 faculty from partnering institutions travelled to Guyana to teach and provide patient care. Development of modified evidence-based clinical guidelines improved quality of care and patient safety outcomes. MMR from direct causes decreased country-wide and at GPHC during the 4-year period. Success was due to shared institutional vision, establishment of partner organizations, resident leadership development, and systems-based improvement. Future challenges include trainee retention and continued sustainability. DISCUSSION: Guyana’s first ObGyn residency program can serve as a model for similar endeavors in global health. Creation of sustainable training programs in ObGyn through international partnerships is essential progress toward achieving MDGs 5 and 8.