Training initiatives for essential obstetric care in developing countries:a 'state of the art' review

Increased international awareness of the need to provide accessible essenti al or emergency obstetric and newborn care in developing countries has resu lted in the recognition of new training needs and in a number of new initia tives to meet those needs. This paper reviews experience in this area so fa r. The first section deals with some of the different educational approache s and teaching methods that have now been employed, ranging from the tradit ional untheorized 'chalk and talk', to competency-based training, to theori es of adult learning, problem solving and transferable skills. The second s ection describes a range of different types of indicators and data sources ([earner assessments, user and community assessments, trainer assessments a nd institutional data) that have been used in the assessment of the effecti veness of such training. The final section of the paper draws together some of the lessons. It considers evaluation design issues such as the inclusio n of medium and Ions term evaluation, the importance of methods that allow for the detection of iatrogenic effects of training, and the roles of commu nity randomized trials and 'before, during and after' studies. Issues ident ified for the future include comparative work, how to keep training afforda ble, and where training ought to lie on the continuum between straightforwa rd technical skills acquisition and the more complex learning processes req uired for demanding professional work.