INVOLVING THE PRIVATE-SECTOR IN IMPROVING OBSTETRIC CARE, ANAMBRA STATE, NIGERIA

Preliminary studies: Of 11 facilities providing obstetric services in the Njikoka Local Government Area, four were private, for-profit insti tutions. Focus group discussions in seven communities revealed a prefe rence for private facilities due to flexible payment schedules, proxim ity, reliable availability of a medical doctor and poor quality govern ment services. Each of the private facilities had one doctor and one m idwife and the bulk of patient care was performed by health aides with no formal midwifery training. Interventions: In 1992, 15 aides from t he private facilities were trained in the recognition and management o f obstetric complications. The training consisted of one week of class room instruction and two weeks of practical training in local missiona ry hospitals. Results: Improvements were assessed by a written test. T he percent of trainees obtaining a passing test mark increased from 33 % (pre-training) to 61% (post-classroom) to 77% (post-practicum). Cost s: The cost of this intervention was approximately US $18000. Conclusi ons: Auxiliaries' skills can be improved with classroom and practical training. The involvement of private sector institutions is important where they provide a substantial proportion of emergency obstetric ser vices. However, maintaining improvements requires sustained efforts. ( C) 1997 International Federation of Gynecology and Obstetrics.