Addressing poor maternal and perinatal outcomes
Dave Woods, MD, FRCP, is Emeritus Associate Professor in the Department of Child and Adolescent Health, University of Cape Town, and Gerhard Theron, MD FCOG (SA), is Professor and Head of the Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, Tygerberg, Western Cape.
Schoon and Motlolometsi draw timely attention to the failure of the current health system to reduce the unacceptably high numbers of maternal and perinatal deaths in South Africa.1 They identify many obstacles, including the lack of appropriate inter-professional education in basic and advanced care. Both knowledge and a good understanding of the principles of prevention, diagnosis and management are needed to change practice. Protocol-driven training and skills workshops alone are unlikely to achieve the desired outcome. What is essential is an integrated package of good planning and management, well-equipped facilities, adequate staffing, shared protocols, good communication and transport, appropriate skills training and learning courses, and inspired leadership to develop a culture of caring. The emphasis should be on learning on-site and not centralised training.
With the limiting constraints on funding, adequate facilities
and appropriately trained personnel for formal teaching,
innovative methods are required to meet the overwhelming need
for in-service training. This daunting challenge could be met by
expanding the current use of the Perinatal Education Programme
to enable groups of healthcare workers to take partial
responsibility for their own continuing learning and
professional growth.2 Experience with over 70 000
participants during the past 20 years plus extensive evaluation
of the improvements in knowledge, attitudes, skills and practice
in prospective trials demonstrate the opportunities offered by
this cheap and effective methodology.3 Based on a broad consensus,
the self-help learning material addresses a wide range of topics
and is conveniently divided into modules and made available in
paper, Internet, cell phone and Facebook formats. With a simple
question-and-answer layout, case studies, self-assessment tests
and clinical skills instructions it could be used to expand
local or provincial training initiatives and promote
standardised care for all mothers and their newborn infants. No
longer can midwives and doctors claim that they do not have easy
access to appropriate learning in order to
provide quality maternity services.
1. Schoon MG, Motlolometsi MWA. Poor maternal outcomes: a factor of poor professional systems design. S Afr Med J 2012;102(10):784-786 (this issue). [http://dx.doi.org/10.7196/SAMJ.6130]
2. Electric Book Works for Eduhealthcare. Cape Town. http://www.ebwhealthcare.com (accessed 27 August 2012).
3. Perinatal Education Programme for the Perinatal Education Trust. Cape Town. http://www.pepcourse.co.za/background/references (accessed 27 August 2012).
S Afr Med J 2012;102(10):786. DOI:10.7196/SAMJ.6216
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