1. Basic Emergency Obstetric Care
Introduction to Training Guidelines, Session Plans & Role of
Trainers
March 07, 2011
Dr. Dinesh Baswal,
Assistant Commissioner, Maternal Health Division,
Ministry of Health & Family Welfare
201-D, Nirman Bhawan
New Delhi

2. What is EmOC ? The Signal functions…
• Parenteral antibiotics
• Uterotonic drugs
• Parenteral anticonvulsants
• Manual removal of placenta
• Removal of retained products
• Assisted vaginal delivery
• Neonatal resuscitation
• Cesarean delivery
• Blood transfusion BasicEmOC
ComprehensiveEmOC

3. Why EmOC?
• Most of the obstetric complications can and should be
managed at PHCs.
• Evidence from States indicates surge in the utilization of
institutional delivery services at 24 x 7 PHCs which are closer
to the poor women in rural areas.
• Provision of services for management of obstetric
complications at these facilities will prevent delays in
treatment.
• Capacity strengthening of MOs posted at these facilities in
diagnosing and managing obstetric complications is
necessary.
• The BEmOC training will help them in the re-orientation of
skills in diagnosing and managing obstetric complication.

4. Whats new?
• To improve skills of providers, training of ANMs/LHVs/SNs as
SBA has already been in place but the MOs who are also the
supervisors of this training need to be reoriented on the
skills.
• A guideline on Pregnancy Care and Management of Common
Obstetric Complications for Medical officers working at PHC
and CHC level was prepared for this purpose in the year 2005.
• However, states could not implement it because of lack of
training tools.
• A 10 days’ package for Medical officers is now in place but
now the guidelines are also prepared as a facilitating tool.

5. Duration of Training
• Residential training of 10 days’ duration.
• Out of 10 days, a minimum of 4-5 days should
be spent in the LR as 24 hours emergency
duty.
• Follow the training schedule and session
plan, as per the guidelines.

6. Eligibility Criteria for Trainers
• Faculty of Obstetrics/Gynaecology and Paediatrics from the
medical colleges/district hospitals/identified training
institutes shall be the main trainers.
• Nominated trainers must undergo orientation training.
– Only willing personnel should be nominated as trainers.
– The trainers need to spare extra time for this programme.
– Not more than 50% of the faculty should be involved in the
training process at any point in time.
• The other staff such as Senior Resident/Registrar, etc., can
supervise the trainee.
• One trainer can take up maximum two trainees and the batch
size would be of 4 to 5 trainees each.

7. Training Site Requisites (Annex I)
• Hospital attached to a Medical College which is recognized by MCI and
follows the norms of service delivery as laid down in “Guidelines for
Pregnancy Care and Management of Common Obstetric Complications by
Medical Officers”.
• Medical College which has sufficient strength of trainers and is imparting
training to post graduate students in Obstetrics and Gynecology.
• Has proper infrastructure and its readiness as per Annexure 1 of the
guidelines.
• Has a minimum delivery load of 150 every month and has facility for
conducting C-section and other obstetrics related surgical interventions.
• Follows all protocols and practices, especially use of Partograph and
active management of third stage of labour. (AMTSL).
• The clinical protocols such as AMTSL, Immediate management of PPH,
Eclampsia and Essential Newborn Care etc. are displayed prominently in
the labour room premises.

8. Annexure I : Checklist for Training Site
Readiness
CHECKLISTS
•Pre training site Readiness
•Daily training site preparedness
(for Theory & Practical Sessions
including Equipments and Drugs)
•Log book
•

9. Training Methodology
• Training methods should be interactive sessions, discussions, bed
side teaching, demonstration of skills, case studies, etc.
• Flexible schedule with less stress on didactic lecture or class room
teaching, more priority to be given to clinical practice.
• Trainer should limit himself/herself to impart knowledge/skills as
per the guidelines.
• Training curriculum has been divided into 10 different sessions.
• Theory lectures can be scheduled as per the convenience of trainer.
Emphasis should be on “Hands on” practice.
• Sufficient teaching material, partographs, case sheets, stationery,
etc., are available.
• Duty register of the trainees should be made available at suitable
places.
• Trainer has to ensure that the quality of the training is maintained.

10. The Training Resource Pack
• GUIDELINES for Pregnancy
Care and Management of
Common Obstetric
Complications by Medical
Officers (Textbook)
• WORKBOOK for TRAINING
of Medical Officers in
Pregnancy Care and
Management of Common
Obstetric Complications

11. The Training Resource Pack
• TRAINEES' HANDBOOK for
TRAINING of Medical
Officers in Pregnancy Care
and Management of
Common Obstetric
Complications
• TRAINERS' HANDBOOK for
TRAINING of Medical
Officers in Pregnancy Care
and Management of
Common Obstetric
Complications

12. LR Roster
• A Labor Room Roster should be prepared by
all the trainer’s at the training sites
• The Training site should be checked as per the
day’s training site checklist a day in advance
• Trainer’s should ascertain that the trainees
follow the Labor Room Roster
• The Labor Room Roster should be made
available to the Site visiting teams from
Centre or State

13. Expectations from the ToT Facilitators
• Handholding to:
Ensure that the Trainers abide by the Guidelines and
Quality training is imparted through
• Pre training – Ensuring that all protocols are in place,
Training Load calculation
• Training – Pre-approval of Site Readiness through Site
inspection
• Post Training – Regular Follow up of trainees in practicing
acquired skill set
Ensuring that the expected outcomes are delivered
M & E field visits using the Checklists
Quarterly M & E reports to be shared with the RCH
Officer at the State Level and GoI

14. Expectations from Master Trainers
• All the Sessions are delivered as per the Session Plan and the
lectures are delivered using standardised presentations in the 21
hour schedule
• Trainees must learn to discharge/make referral of the patients
during and after training as per the Annexure II and III of Trainee’s
Workbook given in the Guidelines.
• The trainees should ensure privacy of the woman and respect her
rights.
• Ensure Record Keeping by the Trainees which includes:
– Record of all their activities in the Trainee’s Hand Book & Work
book and complete the specified number of activities as in
Annexure II (Recommended Client Practice by Trainee).
– Attendance records have to be maintained, kept certified by the
trainer/supervisor and kept with the trainer.
– A copy of the records related to certification will be maintained
at the training institution as in Annexure IV (Record/
Assessment form for the Trainee).

15. Session Plan
• Stick to the Session Plan
• Presentations using the
Stantardized templates to be
provided by GoI
• Maintain uniformity by following
the “Guidelines for Pregnancy Care
and Management of Common
Obstetric Complications by
Medical Officers”
• Trainees are to be posted at Ante
natal OPD/LR/Post Natal ward or
any other relevant place during
the practice session (minimum of
6-8 hours per day)

16. Session Plan Contd…
• Maximum efforts should be
undetaken to give hands on
training to enhance skills rather
than didactic lectures
• Session should be interactive
• The trainers should be flexible
in following the suggested
lecture schedule and it can be
held at any point of time in the
day depending on the situation

17. Annexure II : Recommended Client
Practice by Trainee
• The trainers will ensure and
monitor quality and practicing of
these skills
• Trainee should keep a daily
signed Cumulative Client Practice
Record.
• This record will be utilized by
Trainer for certification
• In case there is no client/patient
on whom any of the above skills
cannot be performed, then the
trainer should use models or
innovative approaches suggested
to enable the trainees to perform
the skills.

18. Annexure II : Referral Slip (Trainee’s
Handbook)
Trainee must learn to
discharge/make referral of the
patients during and after training:
• Both these activities are very
important and as such the MOs
deputed for the training must
practise these sincerely, so that
they can replicate them at their
health facility.
• Any patient being referred from
one facility to another must have
a referral slip, giving details as in
Annexure II.

19. Annexure III : Discharge Slip (Trainee’s
Handbook)
• All the patients
admitted for pregnancy
and delivery care,
should be given a
properly filled discharge
slip, while getting
discharged from health
facility as in Annexure
III.

20. • Skills’ assessment should be conducted as an integral
component of performance during the posting and
practicing of the skills.
• Assessment criteria are “Satisfactory/Unsatisfactory”
as per the assessment of the trainer.
• During clinical sessions, trainer has to certify the
findings on the case sheets filled by the trainee.
• In case the trainer is not available or is off duty
during performance of skills suitable supervisor
should be deputed for the same.
Assessment & Certification

21. Assessment & Certification …
• The trainer must supervise at least 25% of the number
of cases mentioned in recommended client practice as
in Annexure II.
• In situations where enough cases are not available,
hands on practice should be given on
mannequins/models.
• The trainees will be graded as satisfactory / needs re-
orientation as per their overall performance. (> 70 % is
satisfactory as per Annexure II)
• Those trainees certified as “unsatisfactory” will have to
repeat 7 days of the training at the respective training
institute before satisfactory completion of the training.

22. Training Session Assessment
(Workbook)
• Page 1.1 of the
Workbook
• The details of the
Training Session should
be recorded by the
trainee
• The result of the
Assessment need to be
mentioned and signed by
the trainers

23. Annexure IV : Record/ Assessment
form for the Trainee (Pg 73 trainer’s)
• Trainee to be assessed on the 17
activities of the Recommended
Client Practice by Trainee in given
in the Trainer’s Handbook
• Observe the Trainee’s for all the 17
tasks stated in the this annexure
and grade the same as satisfactory
or unsatisfactory
• If a trainee is satisfactory for 70 %
or more of the tasks i.e. a minimum
of 12 tasks the trainee can be
certified otherwise he/she will
need reassessment and will have to
repeat the course for 7 days at the
institution at a later date

24. Expectations from MOs
• The trainees should adhere to the schedule as per the session
plan
• Trainees are expected to go through the topics of the sessions
given in “Guidelines for Pregnancy Care and Management of
Common Obstetric Complications by Medical Officers”,
beforehand and discuss these with the trainers during the
sessions.
• Each trainee must fill in his/her observations in the case
sheets (given in the workbook) during practice sessions,
which would be certified on the spot by the
trainer/supervisor.
• The trainees must work at least for 5 days in the LR for 24
hours emergency duties as per the roster.

25. Expected Outcomes of BEmOC
Training
“Skilled EmOC personnel”
• Provide quality care and counseling to the woman during antenatal,
intranatal and postpartum period.
• Identify danger signs during pregnancy, delivery and postpartum period
along with the danger signs in the newborn and provide supportive care
prior to referral.
• Monitor labour using partograph.
• Practice active management of third stage of labour.
• Provide step wise essential newborn care to all the new borns and new
born resuscitation, if required.
• Make referral of complicated cases after initial management and
stabilization of the patient.

26. Annexure 3
Trainers’ and Trainees’ Feedback Form
Trainer’s and trainee’s feedback
should be recorded and provided to
the training teams and Centre for
continuous improvement of the
BEmOC Training

27. Way Forward for NIHFW
• Ensure development of National Trainer’s Pool to meet
shortcomings of Trainers in the States
• States which have surplus Trainer’s pool can be identified by NIHFW
and these trainers can be resourced for deficient States
• NIHFW should keep track of the trainings and inform the GoI of the
trainings being rolled out the State and District level a week in
advance so that arrangements for on-site visit of the training can be
planned.
• NIHFW needs to continuously assess the need of the Master
Trainers for each State and need to build the pool of trainers in the
State

28. Way forward for Trainers
• RCH Nodal Officer should liaison with the Medical College for smooth
conduction of quality transformative training
• RCH Nodal Officer will also keep a database of Master Trainers and
continuously get feedback from them
• Rational Deployment of Trained Personnel in the Priority Facilities viz.
24 x 7 PHCs
• Feedback from trainer / trainees for continuous improvement of
training (Annexure III: Trainer’s & Trainees feedback form)
• Assisted Delivery equipments to be available at the facilities at the
identified institutions
• Training has to be rolled out within 3 months to minimize inherent
losses
• The Training Plan and list of trained MOs should be shared on an
ongoing basis with the Maternal Health Division of the GoI
• Monitor trainees for practicing skills after the training
• Training Plan for trainer’s Need to identify those who are practicing and
those not practicing
• Of one batch how many are certified, training to know wastage factor
and know whether right candidates are identified

29. Hoping for a Successful Endeavor…
Thank you !