Where there is no anesthetist--increasing capacity for emergency obstetric care in rural India: an evaluation of a pilot program to train general doctors.
OBJECTIVE
The lack of anesthesia providers in rural public sector hospitals is a significant barrier to providing emergency obstetric care. In 2006, the state of Gujarat initiated the Life Saving Anesthetic Skills (LSAS) for Emergency Obstetric Care (EmOC) training program for medical offers (MOs). We evaluated the trained MOs' experience of the program, and identified factors leading to post-training performance.


METHODS
The sample was chosen to equally represent performing and nonperforming LSAS-trained MOs using purposive sampling qualitative interviews with trainees across Gujarat (n=14). Data on facility preparedness and monthly case load were also collected.


RESULTS
Being posted with a specialist anesthesiologist and with a cooperative EmOC provider increased the likelihood that the MOs would provide anesthesia. MOs who did not provide anesthesia were more likely to have been posted with a nonperforming or uncooperative EmOC provider and were more likely to have low confidence in their ability to provide anesthesia. Facilities were found to be under prepared to tackle emergency obstetric procedures.


CONCLUSIONS
Program managers should consider extending the duration of the program and placing more emphasis on practical training. Posting doctors with cooperative and performing EmOC providers will significantly improve the effectiveness of the program. A separate team of program managers who plan, monitor, and solve the problems reported by the trained MOs would further enhance the success of scaling up the training program.
Indian Institute of Management, Ahmedabad, India. dileep@iimahd.ernet.in
Dileep
D
Mavalankar
Katie
K
Callahan
Veena
V
Sriram
Prabal
P
Singh
Ajesh
A
Desai
D000773:Anesthesia, Obstetrical; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D003906:Developing Countries; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006078:Government Programs; D006801:Humans; D007194:India; D007407:Interviews as Topic; D008297:Male; D010821:Physicians, Family / Q000193:education; D010865:Pilot Projects; D011247:Pregnancy; D012424:Rural Population