What is needed for taking emergency obstetric and neonatal programmes to scale?
Scaling up an emergency obstetric and neonatal care (EmONC) programme entails reaching a larger number of people in a potentially broader geographical area. Multiple strategies requiring simultaneous attention should be deployed. This paper provides a framework for understanding the implementation, scale-up and sustainability of such programmes. We reviewed the existing literature and drew on our experience in scaling up the Essential Steps in the Management of Obstetric Emergencies (ESMOE) programme in South Africa. We explore the non-linear change process and conditions to be met for taking an existing EmONC programme to scale. Important concepts cutting across all components of a programme are equity, quality and leadership. Conditions to be met include appropriate awareness across the board and a policy environment that leads to the following: commitment, health systems-strengthening actions, allocation of resources (human, financial and capital/material), dissemination and training, supportive supervision and monitoring and evaluation.
Maternal and Infant Health Care Strategies Research Unit, Medical Research Council of South Africa and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Anne-Marie
AM
Bergh
School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia and Medical Research Council South Africa, Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa.
Emma
E
Allanson
Maternal and Infant Health Care Strategies Research Unit, Medical Research Council of South Africa and Clinical Head, Obstetrics and Gynaecology Department, Kalafong Hospital, University of Pretoria, Pretoria, South Africa. Electronic address: robert.pattinson@up.ac.za.
Robert C
RC
Pattinson
D057191:Capacity Building / Q000458:organization & administration*; D036861:Delivery, Obstetric; D004630:Emergencies; D005260:Female; D006291:Health Policy; D006801:Humans; D007224:Infant Care / Q000458:organization & administration; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000628:therapy*; D009774:Obstetrics / Q000193:education / Q000458:organization & administration* / Q000592:standards; D011247:Pregnancy; D016730:Program Development; D013019:South Africa
emergency obstetric and neonatal care; implementation; scale-up