Task shifting to improve access to emergency obstetric care in health facilities: Building capacity of community health extension workers

Northern Nigeria has one of the highest maternal mortality ratios in the world (up to 2,000 per 100,000 live births) (Adamu et al 2003). A major impediment to improving maternal health and attaining MDGs is lack of human resource capacity and availability in rural areas. One of the critical interventions of safe motherhood initiatives is the presence of a skilled health care provider with midwifery skills at birth. In several communities, Community Health Extension Workers (CHEWS), though not recognized as skilled birth attendants, are the only health care providers available to conduct deliveries in hard-to-reach areas. The Partnership for Transforming Health Systems (PATHS2) programme is building capacity of CHEWs in northern Nigeria through Advanced Life Saving Skills (ALSS) trainings. In this study, 94 CHEWS in Kano state were trained on ALSS using a competency-based approach which consisted of new curriculum development, a four week training of trainers and a three week step down training of CHEWS. Follow-up supportive supervision was also conducted for the trainers and CHEWS. Results show that CHEWS knowledge and skills to provide Emergency Obstetric Care increased from 45% to 75%. CHEWS conducted 2,350 deliveries in 22 facilities after receiving ALSS training. The competency-based training for these lower cadres of health care providers closed the gap in knowledge, skills, and attitudes and lead to improved quality of services delivered at health facilities where other higher-level trained providers were not available.