Vital Strategies believes that comprehensive emergency obstetric and neonatal care (CEmONC), which includes Caesarian Section surgery and blood transfusions, can and must be available locally to all delivering women. This can only be achieved in countries experiencing acute doctor shortages by task-sharing with non-doctor health providers, who can be specially trained in CEmONC. Then, once CEmONC capacity becomes consistently available, far fewer women will die in childbirth, far more women will choose to deliver their children in health facilities, and the health facilities will become more trusted hubs for healthcare service delivery in general.
To implement our vision, Vital Strategies recognizes that our most important partner is the government of the country where we work, both at the national and at the local levels. We secure government engagement and commitment in advance and then work with them every step of the way to build and sustain CEmONC capacity. We work in government operated health facilities and train providers selected by the government for the task-sharing roles. Our integrated model has proven that CEmONC service delivery at the local level through task-sharing can decrease the proportion of women dying in childbirth by half, while at the same time increasing the number of women delivering in our supported facilities by 50% or more.
Our approach incorporates four central elements:
Task-sharing to fill the provider gap: Vital Strategies trains mid-level healthcare workers in CEmONC to ensure women delivering even in the most remote regions have access to this and other lifesaving procedures. Once the province of only doctors, evidence has shown that using intensive training to allow “task-sharing” of some critical procedures – including C-Section - to non-doctors is safe and effective.
Supportive supervision and mentoring: Building skills and capacity depends on ongoing support and management across facilities, connecting the newly trained providers with doctors who can mentor them as they put their skills into practice. In addition to frequent on-site supervision, we provide opportunities for continuing medical education, a 24-7 emergency call system manned by obstetricians if a provider needs extra support, remote e-learning courses, weekly clinical conference calls and periodic clinical audits. All of this supervision and mentoring creates a sense of a supportive, reliable community that helps the providers hone their skills, feel connected, and develop confidence.
Integration with host government systems: Vital Strategies partners with the health system of the host country and engages local commitment and support before implementation. We seek to build capacity and train officials such that we will be able to hand over management of the capacity in its entirety once the CEmONC system has taken root. Local officials select all of the providers who are trained by the program, and they participate actively in on-site supervision visits throughout the life of the project. In this way, they are fully aware of the project’s accomplishments and trained in how to supervise and maintain the capacity once donor funding ends.
Driving demand for facility delivery: Using strategic communication including mass media such as radio ads, community-level media and social media, we target expecting women and families to encourage use of a facility for birth. We use innovative messaging – with strategies drawn from successful campaigns in other health areas – that raise risk perceptions of home delivery and encourage expectant mothers and their families to make a plan for how to reach a clinic for delivery.
Our Demonstration Program in Tanzania
Vital Strategies has been running a demonstration program in Tanzania for 9 years. The program operates in 3 remote regions of Tanzania and has proven that our approach can work. Here are some basic facts:
- 50% decline in the proportion of maternal deaths
- 52% increase in the number of women using supported facilities overall
- 45 Assistant Medical Officers trained to do CEmONC
- 65 nurse-midwives and clinical officers to provide anesthesia
- Over 100,000 deliveries assisted
- Over 10,000 C-Sections performed
- 1464 Vacuum Extractions performed