Population Council Research that makes a difference

The AMTSL/ENC integrated training program was well received by service providers at all health center levels. Observation of service provider practices showed a general mastery of the key stages of both AMTSL and ENC. However, the work environment and unavailability of essential materials remained a barrier to improved care, particularly for newborns.

Integration of AMTSL and ENC into the maternal/neonatal/children’s health program

Both AMTSL and ENC have become essential components of the integrated package of reproductive health services in the five regions of Senegal. All 170 service providers interviewed at various health centers had received training in AMTSL and ENC; 168 of these providers were trained within the last six months. The introduction of the new protocols was well accepted by providers, creating a foundation for future improvement in reproductive health care in Senegal. Successful scale-up can be achieved with efficient material, equipment, and infrastructure support.

Widespread service provider knowledge of key stages in AMTSL and ENC

Integrated training in AMTSL and ENC effectively reached service providers and improved their knowledge of AMTSL and ENC protocols. Ninety-three percent of service providers interviewed correctly described the three key steps of AMTSL (administration of oxytocin, cord traction, and uterine massage). The five key elements of ENC were identified by eight out of ten caregivers.

Improved practice of AMTSL and ENC

Training in and increased knowledge of AMTSL and ENC protocols led to effective practice by service providers. The three stages of AMTSL were practiced by over 94 percent of the caregivers observed. The five elements of ENC were performed by a slightly lower percentage of caregivers, largely on account of lack of essential medicine and/or equipment. Over 80 percent of service providers performed four out of five ENC elements, excluding the administration of Vitamin K, which was only performed by 69 percent of service providers. These simple procedures have been shown to cost-effectively improve maternal and neonatal health. With improved infrastructure, the integrated training has the potential to improve reproductive health in Senegal.

The study also revealed barriers to the effective practice of AMTSL and ENC at health centers. The work environment of the caregivers provided weak support for the practice of AMTSL and ENC. There was a lack of available medicine and supplies for basic care, particularly for newborns. Only 30 percent of service providers stated that they had access to the supplies necessary to provide newborn care. In addition, low levels of information reporting and documentation cause insufficiencies to continue. Greater supervision of health centers would improve the reporting of services, costs, and information, as well as strengthen service provider knowledge. Such material and personnel support is necessary to scale up the program effectively.

From this evaluation, recommendations were formed to improve the integration of AMTSL and ENC into Senegal’s reproductive health services. Among others, they include:

• Ensure the availability of all products necessary for AMTSL and ENC and improve storage conditions;
• Promote on-site supervision and support to strengthen knowledge gained from training; and
• Focus on data reporting through systematic registration and methods to facilitate documentation.

A strategy for the reduction of maternal and neonatal mortality (PDF) 
Population Council
Brief
Publication date: 2010


Intégration des Services au Sénégal (PDF) 
Population Council
Brief
Publication date: 2010


Integration of services in Senegal (PDF) 
Population Council
Brief
Publication date: 2010


Private sector's role in health service provision in Senegal (PDF) 
Population Council
Brief
Publication date: 2010


Rôle du secteur privé dans l'offre de services de santé au Sénégal (PDF) 
Population Council
Brief
Publication date: 2010


Une bonne surveillance de la grossesse pour préparer l'accouchement (PDF) 
Population Council
Brief
Publication date: 2010


Une stratégie pour la réduction de la mortalité maternelle et néonatale (PDF) 
Population Council
Brief
Publication date: 2010