MCAI's Strengthening Emergency Care programme (SEC) undertaken in collaboration with the Advanced Life Support Group (ALSG) and in partnership with the Ministry of Health and World Health Organization began in The Gambia in 2005.
In 2015, the United Nations Children’s Fund reported 730 maternal deaths per 100 000 live births, 28 neonatal deaths per 1000 live births and a lifetime risk of maternal death of one in 39. MCAI data, reported later, shows that these figures are a serious under-estimate. The under 5 year mortality rate was 74/1000 live births and the infant mortality 28/1000 live births.
The State of the World's Midwifery reported 121,000 pregnancies in 2012 with 5 midwives per 1000 live births and an intrapartum still birth rate of 12/1000 births. The absence of appropriate training in emergency maternal and neonatal care means that many women and girls face life-threatening situations in all stages of pregnancy. Many women die or are left disabled due to the lack of appropriate and timely treatment.
Strengthening the hospital care systems
Since February 2005, MCAI has provided large amounts of essential drugs, medical and surgical supplies and surgical instruments to the 3 hospitals/major health centres in which we have been working. MCAI has also provided emergency equipment such as portable ultrasound scanners, oxygen concentrators, pulse oximeters and neonatal platform incubators for resuscitation. We have provided 750 MCAI textbooks for doctors and other front-line health workers in all hospitals and major health centres in The Gambia.
We have renovated and refurbished maternity wards, labour and delivery units, operating theatres, and children’s wards.
Working with traditional birth attendants and ambulance drivers, we have organised emergency transport systems to increase the number of births undertaken in hospitals.
This work has been implemented in Basse, Brikama, and Essau regions, covering a population of > 500,000 people.
Short training courses in managing emergencies in pregnancy, the newborn and the child throughout The Gambia
From 2006 to 2014, approximately 940 health workers underwent training lead by the Advanced Life Support Group (ALSG).
Advanced obstetric training programme and continued strengthening of the emergency care system at Brikama Major Health Centre
Despite the Strengthening Emergency Care project described above, and other initiatives over the last 10 years, maternal mortality rates remain high and inaccurately reported, particularly in rural as compared to urban areas of the country. In addition, there is a recognized paucity of skilled obstetric practitioners in the Gambia, especially in rural areas.
In response to this situation, and after the successful implementation of a similar task-shifting project in Liberia, in August 2014, the MOHSW, MCAI and ALSG initiated a pilot Advanced Obstetric Training Programme for junior doctors and senior midwives at Brikama Major Health Centre. As part of this programme there was a need also to continue to strengthen the systems in Brikama MHC to enable and support effective training and service delivery.
Development of life-saving hospital care for new-born infants at Brikama Major health Centre
Currently, and despite around 6000 births per year in the facility, there is no provision for the basic hospital care of those babies who need life-saving emergency treatment.
There are also no doctors or nurses trained in basic hospital care for the newborn infant available in Brikama Major Health Centre. It is not surprising therefore that both mortality rates and the prevalence of permanent life-long developmental damage for infants born at Brikama MHC remain extremely high.