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Karla Krause
BML 305
Howard E. Rhode
6 November, 2014
ALSO Provider Course - Proposal from Costa Rica - Final
Every day approximately 800 women die from preventable causes related to
pregnancy and childbirth. The high number of maternal deaths in some areas of the world
reflects the inequities in access to health services and highlights the differences between
rich and poor. Almost all (99%) corresponds to maternal mortality in developing
countries. Skilled care before, during and after childbirth can save the lives of pregnant
women and newborns.

Figure 1: WHO Maternal

Mortality Ratio MMR Map.

Figure 1 above illustrates countries where untrained individuals carry out most
deliveries, Maternal Mortality Ratios (MMR) are the highest (500-1000/100,000 live
births) and never fall below 100/100,000 (e.g. Ghana, Nepal, Afghanistan). In countries

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where skilled attendants linked with a referral system carry out most deliveries,
irrespective of whether birth is at home, maternity homes or hospitals, MMR can be
reduced to 50/100,000 (e.g. China, Armenia, Sri Lanka). Costa Rica lies in the >80.
Although Costa Ricas Maternal Mortality Radio (MMR) ranks 52 out of 181
countries, there still is a need for healthcare professionals to have the knowledge and skills
to manage the emergency conditions that can occur during childbirth. Providing an ALSO
Provider Course in Costa Rica would deliver an enormous impact keeping the MMR at a
low.
BACKGROUND
The Advanced Life Support in Obstetrics Program (ALSO) was developed in 1991
by the University of Wisconsins Department of Family Medicine. The American Academy
of Family Physicians (AAFP) purchased the program and its copyright in 1993. ALSO has
trained more than 70,000 maternity care providers in the U.S. since 1993 and more than
160,000 worldwide. The ALSO Provider and Instructor Courses are administered in 62
countries, helping health care providers through the world.
The ALSO Provider Course is a two day course, which utilizes a multidisciplinary
approach to teaching a standardized, evidence based curriculum on effectively managing
obstetrical emergencies and decreasing adverse outcomes. Limited evidence suggests it
can be effective and sufficient in enhancing the knowledge and skills of prehospital and
disaster medicine clinicians. The course objectives set in the national medical body as a
means of monitoring and reducing maternal mortality in the country.

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OUR MISSION
Costa Ricas mission is to incorporate and authorize all Medical Related
Professionals and Technologists, in order to ensure the proper practice of the profession in
all areas, contributing to the achievement of the development of the populations. The
College of Physicians and Surgeons of Costa Rica and its commitment to continuing medical
update benefit the practice and the welfare of the population in Costa Rica.

Figure 2 shows the

increase in maternal mortality
from 1990-1995. It declines and
stays steady from 1995 until a
Figure 2: Maternal Mortality from 1990-1995 in Costa Rica.

significant decrease in 2005-2010.

After 2010, it again increases.

Costa Rica witnesses the following:

Complications of a labor and delivery

Hypertensive disorders in pregnancy, childbirth and Puerperium
Puerperal infections
Amniotic Fluid Embolism
Disseminated Intravascular Coagulation
HELLP Syndrome
Bleeding in the Third Quarter
Postpartum Hemorrhage

All of these conditions could be prevented if the appropriate individuals have

adequate training provided by an ALSO Provider Course. Our goal is to train family
physicians and general practitioners from a variety of health practices in our area so they
can reach out and provide the best health care to patients.

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FUNDING:
Funding is the fuel on which the program
runs and an important asset in maintaining the
growth of this program. In the table provided
below, Costa Rica will ensure a minimum of 25 participants in each class and collect $110
registration fee totaling $2,750. Each instructor will receive an honorarium of $800 along
with reimbursement for meals, transportation and hotel accommodations once confirmed.
The AAFP will charge Costa Rica $145 per manual for the 25 minimum participants
to be paid on an annual basis.
Costa Rica:
$110 registration x 25 minimum participants (subject
to annual or semiannual increases as defined by the
Governing Board)
$800 Honorarium for ALSO Instructor
Meals, transportation, hotel accommodations (TBD)
(paid by the College of Physicians and Surgeons of
Costa Rica)
American Academy of Family Physicians:
$45 per manual x 25 minimum participants (paid on
an annual basis)

$2,750
$800
To be determined

$3,675

* Financial breakdown based on one month.

CHALLENGES AND BARRIERS

The Social Security institution, the main physicians employer of the Costa Rica, has
a limited budget. The program does not involve an enormous expenditure on either the
AAFP or the country providing it. Benefits of this program will result in the knowledge and
fulfillment for those attending.

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Individuals will learn and be able to go back in
their areas and provide for those in need.
In order to reduce the current mortality rate in
Costa Rica will decrease to what it was in 1990-2010, we
can begin training physicians in areas and improve those
areas away from Central Valley.
Far too many pregnant women and their newborns

Images compliments of Lee Dresang, MD

continue to die, or suffer significant morbidity. This is not a matter of finances or lack of
understanding of WHY; it is willpower and coordinated efforts. Providing an ALSO
Provider Course in Costa Rica would deliver an enormous impact keeping the MMR at a
low. We can all have a role to play. What we do and support matters in the world.

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Work Cited
Advanced Life Support in Obstetrics (ALSO). N.p., n.d. Web. 31 Oct. 2014.
Dresang, Lee. 2012. PDF file.
WHO World Health Organization. WHO / World Health Organization. N.p., n.d. Web. 31.
Oct. 2014.