Health care workers experiences in emergency obstetric care following implementation of an in-service training program: case of 2 Referral Hospitals in Botswana.

Ludo Nkhwalume,Yohana Mashalla

doi:10.4314/ahs.v21i1.9s

Abstract

Maternal mortality rate remains a challenge in many developing countries. This study explored experiences of Health Care Workers on Emergency Obstetrics Care (EMOC) in-service training and its effect on maternal mortality. Descriptive qualitative study design was conducted using in-depth interviews and focus group discussions. Participants were EMOC trained midwives and doctors purposively selected from the 2 referral hospitals in the country. Data were transcribed verbatim, coded, and analysed using Grounded Theory approach. Four themes emerged including training, EMOC implementation, maternal death factors and EMOC prioritisation. The duration of training was viewed inadequate but responsiveness to and confidence in managing obstetric emergencies improved post EMOC training. Staff shortage, HCWs non-adherence and negative attitude to EMOC guidelines; delays in instituting interventions, inadequate community involvement, minimal or no health talk to women and their partners and communities on sexual reproductive matters and non-prioritisation of EMOC by authorities were concerns raised. Strengthening health education at health facility levels, stakeholders' involvement; and prioritising EMOC in-service training are necessary in reducing the national maternal mortality.

Highlights

Maternal mortality rate remains a challenge in many developing countries
Our findings indicate the need for policy makers to prioritise Emergency Obstetrics Care (EMOC) in-service training so that all relevant health care workers are trained; ensure availability of resources, address shortage of staff and allocate resources where they are critically needed, increase duration of training and review of policies
We found that only a handful of staff at Princes Marina Hospital (PMH) and Nyangabgwe Referral Hospital (NRH) were trained on EMOC and participants expressed concern on the two week duration of training as being inadequate and suggested be increased so that healthcare workers could have more time to practice and have an opportunity to attend to patients under supervision of the facilitators/experts

Summary

Introduction

Objectives: This study explored experiences of Health Care Workers on Emergency Obstetrics Care (EMOC) in-service training and its effect on maternal mortality. Results: Four themes emerged including training, EMOC implementation, maternal death factors and EMOC prioritisation. Health care workers experiences in emergency obstetric care following implementation of an in-service training program: case of 2 Referral Hospitals in Botswana. In 2017, about 295 000 women died during and following pregnancy and childbirth with majority of the deaths (94%) occurring in low and middle income countries. Other complications may exist before pregnancy e.g. diabetes, In Botswana about 94% of pregnant women attend antenatal care services, 99.8% of the deliveries occur in health facilities and postnatal attendance stands at 85.2%.

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Conclusion