Mali is characterised by deep and chronic poverty in rural areas where access to basic health services, in particular perinatal care, is of serious concern. Due to a shortage of health workers, with only three of them per 10,000 inhabitants, 56% of deliveries are not attended by skilled staff and this figure rises to 85-99% in the most vulnerable regions. Maternal mortality is mainly due to postpartum hemorrhage and hypertensive pregnancy diseases, while neonatal mortality is mainly caused by obstructed labour, birth asphyxia and complications of prematurity. The project aims to adequately deal with each of these situations.
In these settings with difficult access to quality health care, mothers and their babies are the most vulnerable, particularly at birth. Tdh is committed to their survival and wellbeing. It is with this background that we have developed a perinatal health programme in Mali in order to reduce stillbirths as well as neonatal and maternal mortality.
Training health workers to make a difference
As quality of care at birth is strongly determined by health workers' skills, it is essential to develop and maintain these competencies through regular trainings. Practical trainings can be performed on mannequins to learn and improve procedures that allow mothers to give birth safely and newborns to adjust seamlessly to their new lives. These medical simulation techniques make it possible to repeat and control stressful situations without endangering patients' lives. This method, used already a lot in large centres, is now made available by Tdh to birth attendants in peripheral settings: our mobile staff visits every health centre of a whole health district at least once a month to run practical and individual trainings. These decentralised, periodic training sessions enable birth attendants in the most isolated places to receive training in essential procedures that save the lives of mothers and their babies at birth.
A pilot project with success
Our SIMESON pilot project was tested in Mali’s Macina health district between October 2016 and October 2017. During that period, there were nearly 4800 births registered in the district’s health centres. For a whole year, and despite repeated climate and security challenges, a SIMESON Mobile Unit of two midwives trained 68 health workers at 21 health centres in the district. The practical performance levels of all health workers in all the health centres increased dramatically from 37.4% to an encouraging 82.8%. SIMESON has particularly led to impressive improvements in the identification and management of postpartum hemorrhage, newborn asphyxia and low birth weight baby care.
We plan to scale up the project across the whole Ségou health region and to enlarge the package of essential gestures in order to bring the greatest safety to each childbirth. There will be new modules targeting other important causes of maternal mortality such as eclampsia.
SIMESON has been designed to respond to global challenges and to be replicated in other countries and contexts. The project will be standardised in a SIMESON Training Manual that contains all the technical, teaching, administrative, monitoring and assessment guidelines.