PROPOSAL FOR BASIC EMERGENCY OBSTETRICS CARE (BEmOC) TRAINING FOR MEDICAL OFFICERS Back Ground: Andhra Pradesh

wants to achieve NRHM goals of Maternal Mortality i.e. less than 100 by 2012 from 134, steps will have to be initiated to accelerate the annual rate of decline 8.5 of MMR by which AP can achieve NRHM Goal of 100 by end of 2012. Under the Reproductive and Child Health programme, Phase II (RCH Phase II), therefore, a conscious decision has been taken to strengthen capacities of Health care providers and evidence based institutional best practices. To achieve the key results on skilled attendance at birth, it is imperative to train and empower MOs/ANMs/LHVs as skilled birth attendants. In this regard, GoI has taken certain policy decisions which empower Medical Officers, Staff Nurses and ANMs to carry out certain emergency interventions after proper training and they have also been permitted to use drugs in specific emergency situations to reduce MMR. Under the RCH Phase-II, the Government of India envisages that fifty percent of the PHCs and all the CHCs in all the districts would be made operational as 24-hour delivery centres, in a phased manner, by the year 2012. These centres would be responsible for providing Basic Emergency Obstetric Care and Essential Newborn Care and Basic Newborn Resuscitation services round the clock. The State have laid emphasis on Basic Emergency Obstetric Care and Skilled Attendance at Birth in the Project Implementation.

AIMS AND OBJECTIVES The purpose of this training is to enhance the capability of M BBS doctors posted at 24 x 7 PHCs, so that they become proficient in identifying and managing basic obstetric complications and develop the necessary skills and competencies to provide essential obstetric and newborn care at the of first contact with the client. point Specific objectives (knowledge based) After completion of the training, the M Os are expected to update and reinforce their knowledge to:
1. Provide quality antenatal care, intra-partum care, including monitoring of labour

with partograph,active management of third stage of labour and postpartum care.

2. Manage

common obstetric problems such as anemia, hypertensive

disorders of pregnancy including eclampsia, haemorrhage, abortion, puerperal sepsis, prolonged labour, preterm labour, foetal distress, prolapsed cord, twins, etc. and stabilize women before and during referral to the appropriate health facility.
3. Do step wise practice on essential newborn care and take steps to ensure good

health of the baby.

4. Appropriately use steps to prevent infections during pregnancy, child birth

and postpartum period.

5. Make referral of complicated cases after initial management and

stabilization.

Skill based objectives: At the end of the training the participants will be able to practice the following skills as per laid down standards and protocols:
1. Provide quality care and counseling to the woman during antenatal, labour

and postpartum period.

2. Identify danger signs during pregnancy, labour, delivery and postpartum period

along with the danger signs in newborn; provide supportive care prior to referral. 3. Monitor labour using partograph. 4. Practice active management of third stage of labour. 5. Follow routine infection prevention practices during pregnancy and child birth. 6. Provide essential newborn care to all new born and new born resuscitation, if required. Criteria for selection of Medical Officers:
1.

The medical officers who are selected for training should preferable be providing services for normal deliveries.

2.

Medical officers who are working in tribal PHCs where normal deliveries conducted.

3. 4.

The MOs should be staying at the head quarter of PHC. The MOs who are working in high MMR reported areas.

TRAINING SITE

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 M anagement of Common Obstetric Complications by Medical Officers.

Medical College which has sufficient strength of trainers and is imparting training to postgraduate students in Obstetrics and Gynecology.

Has fulfilled the norms for pre-requisite of training site, as mentioned below.

Pre Requisites for the Training Site:

Have proper infrastructure and its readiness as per guidelines. Has a minimum delivery load of 150 every month and has facility for conducting caesareansection 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.

TRAINERS: 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 2 to 4 trainees each.

Roles and Responsibilities of the Trainers: The trainer is expected to have a major influence on the development of the trainees knowledge and skills. Before training, the trainer should ensure that he/she:

Has undergone orientation for this training. These trainers in turn should orient other faculty from their department to the training programme, so that other staff besides them can also be nominated as trainer.

Takes interest in imparting clinical skills to the trainees with emphasis on hands on training.

Creates a positive training environment. Uses interactive training techniques. Ensures quality during the training. Follows the training components and manages time allocation

appropriately.

M onitors and assesses that the trainee is practicing the required skills during and in between the training and ensures that trainee under him/her is constantly supervised even after the trainers duty hours.

Maintains training records.

DURATION OF TRAINING Residential training of 10 days duration. Out of 10 days, a minimum of 4-5 days should be spent in the labour room as 24 hours emergency duty. Batch size: 2 4 MOs per batch per centre Attendence: 100% of attendence would be necessary entire duration of (ten days) trainings, no casual leaves will be granted during the training. In case of any emergence/unavoidable circumstance DM&HO of respective districts will take a decision according to situation, if trainee has to take a leave, his/her training will be extended for those many days. In such case the candidate will have to join same training or later training for those many days declared has having successfully completed the training course. While every effort shall be made in selecting the right candidate, if trainers find that any trainee is not taking interest in the training then the DM&HO will take a decision with consideration with Training Coordinator and Key Trainer for the candidate. The same has to be mentioned in the service record of the candidate, after being reasonably certain of the facts. In such a case, no certificate will be issued to candidates.

Monitoring and Management Training Quality: A district level Monitoring committee to be form in each district consisting of Sr. Gynecologist, Pediatrician (who are involved in the Trainings) PODTT, DM&HO and One from Community Medicine Department of nearby government Medical college, this committee needs to ensure both quantitative and qualitative aspects of the training. A team of officials from CHFW/IIHFW /RTCs shall visit the district and observe the ongoing training programme. In the initial days more than one visit will be made. A checklist for monitoring BEmOC Training will be available at IIHFW and will be circulated to District monitoring committees. The Monitoring Officer/Supervisor will fill this checklist at training site and submit it to the Director, apex Training Institute IIHFW and Joint Director Trainings,CHFW along with the visit report and follow up action. For post training follow up once in 3 to 6 months the key trainer/IIHFW and CHFW Officials shall visit to the PHCs to interact with trainees and assess their skills. Management of Training Programme:

To have uniformity all over the state one day orientation training programme may be conducted to all the key trainers from High focus and Tribal Districts on that day a coordinator from GoI may be called to share their experiences across the country.

Atleast two visits are mandatory by any one of the monitoring team member. The first visit shall be on the first day of the workshop and second visit will be between 5th to 10th day of the programme.

DM&HO shall ensure availability of training module/material to the trainees on the very first day of the training.

The key facilitator will ensure availability of all the records to be maintained during training programme.

Records of all the records/procedures which are observed are conducted/assisted by the trainees to be maintained by the trainer (daily diary).

The key facilitator will make pre and post training evaluation of each trainee.

After completion of the training key facilitator should submit a training completion report to PODTT/DM&HO and records within 3 days after training programme with following details: 1.The details of the training which includes the sessions plan and the methodology. 2. Observations on acquisition of skills as per certification criteria for each trainee in tabular form. 3. Comments in case trainee need more exposure to acquire some specific skills.
4.

The DM&HO will use this report as a basis for the certification of trainee.

Training Material

Regarding Material: The training manual prepared by MOHFW in consultation with GoI will be used for the training. Protocol standards can be used as training aids.

Certification: On successful completion of the training, the key facilitator will issue a certificate. The printed certificate will be issued by DM&HO on the basis of report of key facilitator concerned.

Minimum number of obstetric cases to be completed during the training period: Conduct five normal deliveries. Assist in management of one case of eclampsia and manage one such case. Assist in management of two cases each of retained placenta, APH and PPH and independently manage two from each category. Management of two cases of birth asphyxia.

12 districts and Training Centers for BeMoc:

Sl. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Adilabad

District RIMS

Training Centre

Ananthapur Khammam Warangal Nellore Mahaboobnagar Vizianagaram Srikakulam Visakhapatnam East Godavari West Godavari Kurnool 9

Govt. Medical College Dist. Hospital Maternity Hospital Maternity Hospital Dist. Hospital Dist. Hospital RIMS Maternity Hospital Rangarayya Medical College District Hospital Kurnool Medical college

Table 1 Budget estimates per batch per centre to conduct BEmOC trainings at District Level for Medical Officer
Details
DA (Rate x No. of days x No. of Participants) TA for participants (As per actuals) Accommodation for the trainees (wherever 200X4X10 accommodation is not provided) Honorarium for trainers Pediatrician, Rs.300 x 10 days x 3 Gynecologist, Nursing personnel DPHNO (Rate x Days of training x No. of trainers) Incidental Expenditure (Study material, course material, Photo copying, job aids, flip charts, LCD, and Miscellaneous expenses) (Rate x Days of training x No. of trainers) Lunch, Dinner, Tea and Breakfast (Rate x Days of training x No. of trainers) Secretarial Assistance Supporting staff (Driver etc.) Sub Total IOH 10% of Sub total Grand Total (A) Monitoring by RTC faculty TA* Monitoring Honorarium for RTC Faculty Accommodation for RTC faculty Monitoring Cost (B) Monitoring honorarium for DTT Faculty Rs.300 x 15 days Rs.400 x 3 visits Rs.300 x 3 days Rs.4 00 x 3 days 39,300 3930 43,230 1,200 900 1,200 3,300 4,500 50 X 10days x 1 500 Rs.150 x 10 days x 4 6,000 Rs.200 x 10 days x 4 8,000 200x 10 x 1 8000 9,000 Rs.200 x 4 800

Unit cost
Rs.125 x 10 days x 4

Amount in Rs.
5,000

2,000

10

Monitoring Cost (C) Grand Total For conducting One Bemoc Training at One site A+B+C BEmOC Training 4 batches in each District X 12 Districts X (51,030 X 12 x 4)

4500 51,030 24,49,440

Table 2 Budget estimates for conducting 3 days TOT workshop at IIHFW

Details
Bag, Folder pen, Scribbling pad etc. Modules

Unit cost
Rs.200 x 48 Rs.200 x 48

Amount in Rs.
9,600 9,600 14,400

Accommodation for Participants (Only Rs. 100 x 3 days x one day workshop IIHFW will provide 48 participants 10 rooms for fresh up) Food, Tea and Snacks Honorarium to State trainers Accommodations for GOI officials Secretarial Asst. Charges AV operator & Attender Charges Contingency (Photos, bouquet, certificate etc.) Total IOH 15% of Sub total Sub Total (a) TA for GOI officials TA for State Trainers TA for participants DA for participants Sub Total (b) Grand Total (Sub Total (a + b)) Rs. 15000 Rs. 200 x 3 days x 4 Rs. 1500 x 48 Rs. 50 x 48 x 3 day Rs.150 x 55 x 3 day Rs.600 x 8 sessions x 3 days Rs. 1500 x 3 days Rs. 100 X 3 days Rs. 50 x 3 days x 2

24750 14,400 4,500 300 300 5,000 82,850 12428 95,278 15,000 2,400 72,000 7,200 96,600 1,91,878

11

12

Table 3 Budget estimates for printing of Revised Modules, 2010 Sl. No. Name of the module No of pages Cost per Unit (in Rs.) 90/90/44/Number of copies require d 250 250 100 Total Cost (in Rs.)

1. 2. 3.

Trainees hand book for training Trainees workbook Trainers guide for training Grand Total

169 166 86

22,250 22,250 4,400 48,900

Total Budget for conducting 4 BeMOC trainings in 12 districts Sl. No. 1. Budget estimates for 4 batch BEmOC trainings in 12 Districts to train 192 Medical Officers 2. Budget estimates for conducting 3 days ToT for 12 Districts 4 trainers per each distirct 3. 4. Budget estimates for printing of Revised Modules, 2010 Total 2690218 48,900 Rs. 51,030 X 12 Districts x 4 batches 191878 24,49,440 Tables particulars Total

Twenty Six Lakhs ninety thousand two hundred and eighteen only

13