A training need for rural primary care in Nigeria.

The major causes of maternal death in Nigeria are avoidable and preventable. Many of these deaths occur in the rural health facilities and hospitals which are severely lacking in skilled birth attendants. Of the many strategies that have been developed to reduce avoidable maternal death significantly, increasing the availability of skilled human resources is crucial. The shortage of obstetric specialists, especially in the rural and peripheral health facilities in rural Nigeria where more than 60% of the population resides, has been a major contributing factor to the low number of skilled birth attendants. The increased availability of skilled human resources ensures that all aspects of obstetrics, such as antenatal care, postnatal care and other life-saving interventions, including emergency surgery, is available for women during labour and in the immediate postpartum period. In this paper, we propose a short obstetric-training programme for generalist medical officers to increase the number of skilled birth attendants in both rural and peripheral health facilities in Nigeria. These general practice/family practitioners (GP/FPs) and hospital medical officers (MO), will have designated career structures within the primary and secondary healthcare systems, while the consultant obstetrician and sub-specialists, trained with long postgraduate programmes will function at the urban 'specialists' and in teaching hospitals.