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

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

3. 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 ©

4. 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

5. 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

6. 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% )

7. 2012 - First ‘decentralization’ of Global ALSO® courses in MSF projects at intersectional level
2012 – South Sudan – Afghanistan – Pakistan – Kenya – Chad – Ethiopia – India – Haïti – DRC – Lesotho - Lebanon – Senegal

8. 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%

9. 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:

10. 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

11. Impact in MSF SRH projects?

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

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

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

15. 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

16. 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

17. We need your help!
MSF is looking for gynaecologists, midwives and female doctors

18. Thank you for your attention !