Evaluation of the Advanced Life Support for Obstetrics (“ALSO”) Program in the State of Oaxaca, Mexico

Although Mexico is considered a middle-income country, its maternal and newborn mortality rates are still too high, especially in rural states such as Oaxaca. In line with the focus of the Federal Ministry of Health (MOH) on adequate care for obstetric emergencies (EmOC), in 2009 the Oaxaca MOH adopted the “Advanced Life Support for Obstetrics” (ALSO) program for Ob/Gyns and general physicians as the main strategy for improving technical skills in EmOC and decreasing maternal mortality. The ALSO course is generally recognized as having a beneficial effect on EmOC; however, the impact of the course has never been systematically assessed. ALSO has been offered to over 400 medical providers in the state of Oaxaca, and over 50% of the Ob/Gyns that are presently working at the state's main referral hospital are certified in ALSO. Through a combination of direct observation of management of obstetric emergencies of ALSO-trained versus untrained physicians in this hospital, medical chart reviews, surveys mapping medical supplies, equipment, and available health personnel, and in-depth interviews with MOH and hospital authorities, we are evaluating whether ALSO courses are effective in improving the technical skills and working morale of participating providers in EmOC; especially hemorrhage and severe preeclampsia/eclampsia. We have completed over sixty observations, have started the medical charts' review and have finalized the survey. We are now analyzing the findings and we expect to have final data by September 2011.