Performance needs assessment on emergency obstetrical and neonatal care among providers in the Malanville-Karimama health zone of Benin.

After the brainstorming Days on the "Role of Midwives in Maternal Mortality Reduction" and the dissemination of results of a "Regional Study on Addressing Obstetrical Emergencies" held in August 1999 plus the Emergency Obstetrical and Neonatal Care- (EONC) sponsored roundtable organized in May 2000 a national plan for EONC was developed to provide the framework for improving EONC in Benin. This plan identified the implementation of EONC pilot experiments among the selected priority activities. PRIME II assistance was requested for the establishment of these experiments in the Malanville-Karimama health district. The MOH and PRIME II also agreed to use the Performance Improvement Approach (PIA) for this programs planning and implementation. As the first step of this process a performance needs assessment (PNA) was done in October-November 2000. With the partners the EONC providers needed to identify pilot interventions for improvement of their performance in order to provide a high quality zone. The observations of EONC providers (midwives/nurses and care assistants) combined with in-depth interviews (providers supervisors program managers community members) review of health records and statistics and inventory of service provision centers enabled documentation of EONC performance and providers needs in maternity wards and within the community. This included the potential for EONC to supply at the community level and set up of community partnerships for emergency evacuation systems; as well as an overall increase of EONC quality/access in the zone. The assessment showed a significantly large gap between the desired and the actual performance of the providers in the maternity wards. In fact none of the providers in these facilities (midwives nurses care assistants) was able to perform the tasks relating to obstetrical and neonatal emergencies according to standards. The causes of performance gaps were identified in relation to the information/feedback environment motivation institutional support and knowledge/skills. (excerpt)