title: Involving the private sector in improving obstetric care, Anambra State, Nigeria. The Enugu PMM Team.
abstract: BACKGROUND
  Of 11 facilities providing obstetric services in the Njikoka Local Government Area, four were private, for-profit institutions. Focus group discussions in seven communities revealed a preference for private facilities due to flexible payment schedules, proximity, reliable availability of a medical doctor and poor quality government services. Each of the private facilities had one doctor and one midwife and the bulk of patient care was performed by health aides with no formal midwifery training.
  
  
  METHODS
  In 1992, 15 aides from the private facilities were trained in the recognition and management of obstetric complications. The training consisted of one week of classroom instruction and two weeks of practical training in local missionary hospitals.
  
  
  RESULTS
  Improvements were assessed by a written test. The percent of trainees obtaining a passing test mark increased from 33% (pre-training) to 61% (post-classroom) to 77% (post-practicum).
  
  
  RESULTS
  The cost of this intervention was approximately US $18,000.
  
  
  CONCLUSIONS
  Auxiliaries' skills can be improved with classroom and practical training. The involvement of private sector institutions is important where they provide a substantial proportion of emergency obstetric services. However, maintaining improvements requires sustained efforts.
authors.affiliation: Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu.
authors.forename: W
authors.initials: W
authors.lastname: Chukudebelu
authors.forename: A
authors.initials: A
authors.lastname: Ikeme
authors.forename: J
authors.initials: J
authors.lastname: Okaro
authors.forename: P
authors.initials: P
authors.lastname: Egbuciem
authors.forename: B
authors.initials: B
authors.lastname: Onah
authors.forename: V
authors.initials: V
authors.lastname: Okeke
authors.forename: B
authors.initials: B
authors.lastname: Nwakoby
authors.forename: O
authors.initials: O
authors.lastname: Akpala
authors.forename: D
authors.initials: D
authors.lastname: Nwagbo
authors.forename: A
authors.initials: A
authors.lastname: Ikeagu
mesh_terms: D000488:Allied Health Personnel / Q000191:economics / Q000193:education*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000191:economics / Q000592:standards; D008428:Maternal Mortality; D009549:Nigeria; D011247:Pregnancy; D016730:Program Development