ALSO® MEDECINS SANS FRONTIERES Merete Engell and Catherine Cloquet MSF - Belgium

Figures from International Activity Report 2014 In 2014 MSF was present in 63 countries - 384 projects Neutral – Impartial - Independent Figures from International Activity Report 2014

Reasons for intervention Population affected by … 1. Armed conflict Refugees and IDP's Access to basic health care Nutritional emergencies 2. Epidemics and endemics Nutrition Neglected illnesses HIV/AIDS TB Malaria 3. Natural disaster 4. Health care exclusion Migrants, asylum seekers Populations excluded form health care Gabriele Francois Casini – MSF © Guillaume Binet – MSF © Peter Casaer – MSF ©

SRH components within MSF Life saving actions => activities with biggest impact on reducing maternal mortality EmONC Abortion care Preventive and punctual curative actions Family planning ANC, PNC, STI, PMTCT SGBV Obstetric fistula FGM Figures from the International Activity Report 2014

ALSO® Advanced Life Support in Obstetrics Evidence- based learning To better manage obstetric emergencies Skill sets Team based approach Hands on training Mnemonics Aim: Reduce errors + Save lives ALSO is part of a bigger group of advanced life support trainings eg. Trauma, pediatrics Memory rules based on single lettres Example: postpartum hemoraghe: 4 T’s Tone Tissue Trauma Additional workstations PIH case study C/S indication case study Evidence for basic neonatal care Symphysiotomy Craniotomy Balloon tamponade

ALSO® and MSF 2009: start collaboration 2010: start Global ALSO® courses in Denmark - 2 times/year 2011: The first instructor team Today: 28 certified instructors (pass rate 96,5%) 131 certified providers trained in Denmark (pass rate 95,4% )

2012 - First ‘decentralization’ of Global ALSO® courses in MSF projects at intersectional level 2012 – 2015 South Sudan – Afghanistan – Pakistan – Kenya – Chad – Ethiopia – India – Haïti – DRC – Lesotho - Lebanon – Senegal

Centralized courses score better than decentalized ones Denmark: 95% Field courses: 66% 2012 – 2015: 252 out of 386 participants obtained a certificate in the field Wide ranges in exams scores: Written: 25-90% Practical: 52-94%

Challenges/Barriers Language Education level Different training methods Training equipment Limited pool of instructors Visa issues Security Language related: Need for translation of documents Need for simultanious translation during the training Use of ‘difficult’ words for those English is not their mother tongue Use of difficult formulation (double negation) of exam qeustions for those English is not their mother tongue Educational level Language Medically: LHVs, nurses, midwives, doctors, … Preparing participants:

Solutions MSF addendum to the ALSO ® syllabus  easy to read and now in 8 languages! Pre-course sessions 6 weeks prior to course Translation during course and exam Explanation of multiple choice concept Improvised training mannequins Repeat trainings Implementation of mnemonics in daily work

Impact in MSF SRH projects?

1. Improvement of skills Implementation of « midwife logbook »  also for participants who failed  task shifting Number of vacuum deliveries and MVA  no hard data

2. Harmonisation of protocols Implementation of ALSO® mnemonics in MSF protocols Adapted obstetrical flowcharts Team work is encouraged

3. Training continues at work Hands on training with mnemonics Mnemonics « drills » Staff are more confident to organise trainings

Future forward? Continue Global ALSO ® courses in Denmark for both providers and instructors Further decentralize Global ALSO® courses in MSF projects Systematic post course evaluations Research on impact 2016: first French edition of the Denmark course “instructor CD” Arabic version of the syllabus

Conclusion Global ALSO® in MSF settings is feasible and achieves considerable successes Tools need to be developed and fine-tuned to address differences in participant capacity Positive effects even when participant didn’t pass the exam

We need your help! MSF is looking for gynaecologists, midwives and female doctors www.obstetrician-gyneco.msf.org

Thank you for your attention !