Making the impossible, possible – highlights from the scale up of the emergency obstetric care program in India

A key factor contributing to maternal deaths is the weak capacity at primary health care level to respond to medical emergencies. To address this, the Ministry of health and family welfare, Government of India took a policy decision to build capacities of MBBS doctors to provide high quality emergency obstetric care services. This would result in the operationalization of 2000 first referral units across India and contribute to the prevention and reduction in maternal morbidity and mortality. The scale up was achieved through partnership with the Federation of Obstetric and Gynaecological Societies of India. Other key partners included JHPIEGO, Macarthur Foundation, Averting maternal deaths and disabilities and Avni health foundation. This intensive program includes training in stages (theoretical and practical), supervised drills and examinations. The paper shares experiences gained during the last six years of implementation, as well as challenges and lessons learnt. The program has resulted in setting up and upgrading 4 nodal centers and 34 medical colleges for training and supportive supervision, 235 district training sites for practical training. A resource pool of 333 district trainers, 197 medical college master trainers and certified1221 MBBS doctors has been created. The analysis of results shows an increase in number of emergencies (hemorrhage/abortions/sepsis/malaria/hepatitis) treated at the hospital and decrease in out referrals at sites where the trained MBBS doctors are present. The best practices and lessons learnt are important for India and other countries conducting EMOC capacity building at district and primary health care level to address maternal morbidity and mortality.