Involving the private sector in improving obstetric care, Anambra State, Nigeria. The Enugu PMM Team.

PRELIMINARY STUDIES

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.

INTERVENTIONS

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).

COSTS

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.