> For the complete documentation index, see [llms.txt](https://research.ambitiousimpact.com/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://research.ambitiousimpact.com/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care.md). # Simulation-based training for emergency obstetric and newborn care ## Summary ### Description The quality of maternal and neonatal emergency care remains a critical issue in many low-resource settings. When complications arise during birth, clinicians are often unprepared and have insufficient practice responding to them. This charity will partner with healthcare providers to strengthen emergency obstetric and newborn care through low-dose, high-frequency, hands-on simulation-based training in basic procedures that can prevent long-lasting disability or death, supported by ongoing mentorship and supervision. [**Theory of change**](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/2-theory-of-change.md)**:** The organization is expected to manage a team of master trainers who train and support selected facility staff (in-facility champions) to run weekly refresher simulation and practice sessions for skilled birth attendants. The selected staff receive ongoing coaching and mobile phone-based support to help them maintain these sessions throughout the year. The repeated practice is expected to help skilled birth attendants maintain their clinical skills and apply them during maternal and newborn emergencies. The table below summarizes how we classify this intervention across three dimensions[^1]: | Intervention type | Mechanism of impact | Innovation profile | | ------------------------------------- | --------------------------------------------------------------------------- | ---------------------------------------------------------- | | Provider engagement / Physical Health | Enablement and/or facilitation *(improves an existing third-party service)* | Exploit-lean *(primarily applies an established approach)* | ### Expected impact [**Cost-effectiveness analysis**](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/6-cost-effectiveness-analysis.md)**:** We expect this intervention to be highly cost-effective, ranging from USD 16 to 76 per disability-adjusted life year (DALY), in 2023 prices, in most countries. If the charity has to pay for commodities as well as training, this rises to 25–99 per DALY. While there are uncertainties that could materially affect these estimates, the intervention’s low costs and the expected effectiveness of the practices taught in addressing a major contributor to neonatal mortality mean we expect it to remain highly cost-effective in most well-implemented scenarios. **Scale this charity could reach:** We are very uncertain about the charity’s potential scale. Depending on the country modeled, we estimate that the charity could avert around 77K DALYs per year, with a range of roughly 5K to 360K. While the potential achievable scale is large, we expect the scaling process to be moderately to highly complex because delivery requires an in-person component and each new facility may present different implementation challenges. ### Potential for success [**Strength of evidence**](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/3-evidence-review.md)**:** Evidence is strongest for the [expected impact](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/3-evidence-review.md) of the practices taught to clinicians. We are confident that, when implemented correctly, these basic interventions reduce mortality and morbidity at the population level. Evidence for our preferred [training model is also positive](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/3-evidence-review.md), but we are very uncertain about the magnitude of the resulting change in clinician behavior. ### Neglectedness [**Neglectedness**](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/5-neglectedness-and-geographic-assessment.md)**:** While several large and effective organizations already work in this space, we believe there is considerable space for a new actor—either focusing on neglected geographies or on increasing the frequency and quality of training in places where it happens too infrequently (or otherwise fails to reach its potential, such as due to limited monitoring or commodity stockouts). [**Geographic assessment**](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/5-neglectedness-and-geographic-assessment.md)**:** Our preliminary geographic assessment identified multiple countries that may be strong candidates for this intervention, including Nigeria, Pakistan, Chad, Sierra Leone, or Angola. However, our geographic model is only indicative. Other factors, such as the number of facilities the nonprofit could reach and the proportion of births that take place in facilities, could ultimately determine which countries are most promising. ### Other [**Expert views**](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/4-expert-views.md)**:** Experts were largely supportive of the model, confirming both the need for the intervention and concerns about the quality of care in facilities they had visited or supported. They expressed mixed views on the need for a new charity, reflecting the fact that large-scale implementers of this kind of training already exist in multiple countries. [**Implementation factors**](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/7-implementation.md)**:** Our main concerns are the difficulty of executing this intervention, particularly managing stakeholders in facilities, and reliably monitoring quality of care and clinical outcomes. ## Crucial considerations and known unknowns ### **Is there a believable path to scale for this intervention?** A key challenge to scaling this intervention is ensuring that regular simulation practice becomes embedded in routine facility operations. Without this, expansion risks producing a series of one-off training programs rather than sustained improvements in practice. We therefore think the program should be designed with scale in mind from the outset. This could involve: * Securing support from relevant institutional stakeholders. National and state professional councils may need to approve accreditation pathways, while support from facility clinical leadership will be important for embedding regular practice into facility routines. * Keeping the program affordable enough for governments or facilities to fund at scale. * Training in-facility champions to lead weekly simulation practice, reducing reliance on external trainers and potentially making the model easier to sustain and scale. The availability of validated training materials is an advantage here, allowing founders to focus on developing effective operating procedures and testing how best to scale the program. * Testing lower-cost approaches to support and supervision, such as remote observation and support for in-facility champions. ### **What role will supply chain management need to play?** One of the largest uncertainties is whether the organization will need to support facilities with supplies. The medicines and other commodities needed for basic emergency maternal and newborn care are generally straightforward to stock and supply. However, if key supplies are unavailable, clinicians will not be able to provide adequate care, and the nonprofit may need to provide supply chain support. This would add substantial complexity and may require a different set of skills from the rest of the intervention. We may be able to investigate this question through further desk research or by commissioning on-the-ground research in key target locations. Given the current uncertainty, we strongly recommend that founders initially prioritize facilities, or broader locations, where supply chain support is less likely to be needed. [^1]: See AIM’s full charity taxonomy [here](https://ambitious-impact.gitbook.io/ambitious-impact-docs/explainers-and-house-views/our-charity-taxonomy). --- # Agent Instructions This documentation is published with GitBook. GitBook is the documentation platform designed so that both humans and AI agents can read, navigate, and reason over technical content effectively. Learn more at gitbook.com. ## Querying This Documentation If you need additional information that is not directly available in this page, you can query the documentation by asking a question. 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