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

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

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

4 SRH components MSF within saving Life actions activities with biggest => reducing maternal mortality impact on • EmONC • Abortion care Preventive punctual curative actions and • 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 • - T • better manage obstetric emergencies o • Skill sets – based approach Team – Hands on training – Mnemonics • Aim : Reduce errors + Save lives

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

8 • courses score better than decentalized ones Centralized - Denmark : 95% - Field courses: 66% • 2012 – 2015: 252 out of 386 participants obtained a certificate in the field

9 Challenges/Barriers Language • • E ducation level • Different training methods • Training equipment • Limited pool of instructors • Visa issues • Security

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

11 Impact in MSF SRH projects?

12 1. Improvement of skills Acte Obstétrical 1 : la ventouse obstétricale of Implementation • Formation Signature formateur Date Théorie indications, : in dication, contre - « logbook » midwife prérequis et possibles complications de la ventouse Pratique sur mannequin selon le ABCDEFGHIJ de la ventouse also  for participants Pratique sous supervision Commentaires du superviseur date Signature du superviseur 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 • evaluations Systematic post course • Research on impact • 2016: first French edition of the Denmark course • “instructor CD” • Arabic version of the syllabus

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

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

18 Thank you for your attention !

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