Where there is no anesthetist – increasing capacity for emergency obstetric care in rural India: An evaluation of a pilot program to train general doctors

Mavalankar, Dileep; Callahan, Katie; Sriram, Veena; Singh, Prabal V.; Desai, Ajesh

doi:10.1016/j.ijgo.2009.09.007

Cited by 22 publications

(32 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For instance the post operative outcomes of C sections performed by non physician providers in Malawi were comparable to those of doctors [22]. However the only available ,though early, evaluations of task shifting for EmOC-for both C section and anaesthesia in India are not encouraging and demand greater support [23,24]. The choice revolves around what is the most effective way to improve coverage, reach and quality of EmOC services and reduce its costs in the specific contexts.…”

Section: Discussionmentioning

confidence: 99%

Contracting in specialists for emergency obstetric care- does it work in rural India?

Randive

Chaturvedi

Mistry

2012

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundContracting in private sector is promoted in developing countries facing human resources shortages as a challenge to reduce maternal mortality. This study explored provision, practice, performance, barriers to execution and views about contracting in specialists for emergency obstetric care (EmOC) in rural India.MethodsFacility survey was conducted in all secondary and tertiary public health facilities (44) in three heterogeneous districts in Maharashtra state of India. Interviews (42) were conducted with programme managers and district and block level officials and with public and private EmOC specialists. Locations of private obstetricians in the study districts were identified and mapped.ResultsTwo schemes, namely Janani Suraksha Yojana and Indian Public Health standards (IPHS) provided for contracting in EmOC specialists. The IPHS provision was chosen for use mainly due to greater sum for contracting in (US $ 30/service episode vs.300 US$/month). The positions of EmOC specialists were vacant in 83% of all facilities that hence had a potential for contracting in EmOC specialists. Private specialists were contracted in at 20% such facilities. The contracting in of specialists did not greatly increase EmOC service outputs at facilities, except in facilities with determined leadership. Contracting in specialists was useful for non emergency conditions, but not for obstetric emergencies. The contracts were more of a relational nature with poor monitoring structures. Inadequate infrastructure, longer distance to private specialists, insufficient financial provision for contracting in, and poor management capacities were barriers to effective implementation of contracting in. Dependency on the private sector was a concern among public partners while the private partners viewed contracting in as an opportunity to gain experience and credibility.ConclusionsDensity and geographic distribution of private specialists are important influencing factors in determining feasibility and use of contracting in for EmOC. Local circumstances dictate balance between introduction or expansion of contracts with private sector and strengthening public provisions and that neither of these disregard the need to strengthen public systems. Sustainability of contracting in arrangements, their effect on increasing coverage of EmOC services in rural areas and overlapping provisions for contracting in EmOC specialists are issues for future consideration.

show abstract

Section: Discussionmentioning

confidence: 99%

Contracting in specialists for emergency obstetric care- does it work in rural India?

Randive

Chaturvedi

Mistry

2012

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Mavalankar et al [25] evaluated the experiences of 14 medical officers (doctors with a five‐year degree) in India who received training in Life Saving Anaesthetic Skills (LSAS) for EmOC. Being posted at a healthcare facility without a specialist anesthesiologist and/or nonperforming or uncooperative EmOC provider, led to a higher likelihood of not using the anesthetic skills learned.…”

Section: Barriers and Facilitatorsmentioning

confidence: 99%

Emergency obstetric care: Making the impossible possible through task shifting

Schneeberger

Mathai

2015

Intl J Gynecology & Obste

View full text Add to dashboard Cite

a b s t r a c t a r t i c l e i n f o Keywords:Cesarean delivery Emergency obstetric care Maternal mortality Nonphysician clinician Task shifting Task shifting-moving tasks to healthcare workers with a shorter training-for emergency obstetric care (EmOC) can potentially improve access to lifesaving interventions and thereby contribute to reducing maternal and neonatal morbidity and mortality. The present paper reviews studies on task shifting for the provision of EmOC. Most studies were performed in Sub-Saharan Africa and South Asia and focused primarily on task shifting for the performance of cesarean deliveries. Cesarean delivery rates increased following EmOC training without significant increase in adverse outcomes. The paper discusses the advantages and disadvantages of task shifting in EmOC and the role of this approach in improving maternal and newborn health in the short and long term.

show abstract

“…Strategies applied elsewhere to improve task shifting such as enhanced health service coordination and incentives including salary increments or performance‐based inducements (Mavalankar et al . ) could be applied to improve nurse support and motivation in mining setting.…”

Section: Relevance To Clinical Practicementioning

confidence: 99%

How does the mining industry contribute to sexual and reproductive health in developing countries? A narrative synthesis of current evidence to inform practice

Dawson

Homer

2013

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

Where there is no anesthetist – increasing capacity for emergency obstetric care in rural India: An evaluation of a pilot program to train general doctors

Cited by 22 publications

References 4 publications

Contracting in specialists for emergency obstetric care- does it work in rural India?

Contracting in specialists for emergency obstetric care- does it work in rural India?

Emergency obstetric care: Making the impossible possible through task shifting

How does the mining industry contribute to sexual and reproductive health in developing countries? A narrative synthesis of current evidence to inform practice

Contact Info

Product

Resources

About