Improving emergency obstetric and newborn care in rural India
February 2008
 Mother receives newborn after life-saving cesarean section
done by general doctor in Rajkot District, India. Rural India suffers from a common problem found in developing countries—the lack of high-quality emergency obstetric and newborn care. For every 100,000 births, there are approximately 500 women who die in childbirth. And in a country of well over one billion people, that equates to about 100,000 women dying each year.
In India, medical colleges prepare specialist physicians to treat the complications associated with pregnancy and childbirth. These specialists are typically found in or near urban areas, leaving rural populations to be served mainly by general medical officers, who tend to have limited skills in managing obstetric and newborn complications.
Drawing on a long history of strengthening the ability of front-line health workers to deliver high-quality health care services, Jhpiego partnered with the Federation of Obstetrics and Gynecology Societies of India (FOGSI) in 2004 to train rural medical officers in emergency obstetric and newborn care (EmONC). This effort was funded through a two-year grant from The John D. and Catherine T. MacArthur Foundation.
Using MacArthur funds, three high-quality EmONC training centers were established to implement a FOGSI/JHPEGO-designed EmONC Certification Course to train rural medical officers.
The first component of the EmONC certification process is a
six-week, group-based learning course held at the training centers. Trainees
learn life-saving skills, including how to manage postpartum hemorrhage, eclampsia, sepsis and obstructed labor,
as well as perform newborn resuscitation. Following this coursework, trainees participate in a 10-week, self-directed clinical practicum at designated training district hospitals. Here, under supervision, trainees gain hands-on experience in implementing their new EmONC skills.
At the end of the practicum, trainees are sent back to their rural worksites to begin providing EmONC
services to the communities they serve. Trainees conduct initial
self-assessments to identify potential provider and facility performance gaps
and develop strategies for improving performance. External assessments are
subsequently conducted by the Indian College of Obstetricians and Gynaecologists, over the course of two separate visits, to ensure that trainees have successfully transferred their learning and skills to their worksites. Upon successful completion of these assessments, trainees and their facilities receive limited license from the State Ministry of Health to provide comprehensive EmONC services.
Over the two-year life of this program, more than 49 medical officers were trained in EmONC, expanding the access to life-saving obstetric and newborn care to 21 new locations throughout rural India.
Based on the success of this public-private partnership, the Government of India recently awarded FOGSI a direct grant of US$5 million to expand its efforts. Over the next five years, with ongoing technical assistance from Jhpiego and again funded by The MacArthur Foundation, FOGSI will be spearheading a rapid scale-up of the EmONC Certification Course to further expand rural access to skilled obstetric and newborn health workers—saving the lives of mothers and their babies.
About Jhpiego
For 35 years, Jhpiego, (pronounced "ja-pie-go"), has empowered front-line health
workers by designing and implementing simple, low-cost, hands-on solutions that
strengthen the delivery of health care services, following the
household-to-hospital continuum of care. We partner with community- to
national-level organizations to build sustainable, local capacity through
advocacy, policy and guidelines development, and quality and performance
improvement approaches.
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