Advocacy & Health Policy: Reducing Maternal Mortality in Sub-Saharan Africa through Improvement of Surgical Obstetric Skills

SOO Training Group in Kampala at Mulago
University Hospital

Surgical training is a critical need that remains unmet by the in-country health professionals aiming to prevent maternal and newborn death and iatrogenic fistula in sub-Saharan Africa.

Structured Operative Obstetrics™ (SOO) Trainings

ACOG recently collaborated with the Association of Obstetricians and Gynaecologists of Uganda (AGOU) and residency programs in Uganda to conduct Structured Operative Obstetrics™ (SOO) trainings for university faculty and ob-gyn society members in Uganda. The SOO™ course is designed by the Canadian Network for International Surgery (CNIS) and is designed to teach participants the management and technical surgical skills needed to perform a cesarean delivery and other operative obstetric skills.

The goal of the SOO training course is to accelerate surgical proficiency. The training consists of three main components: 12 lecture series, seven laboratory sessions, and a clinical practicum. The interactive lectures include reviews of basic topics in obstetrical and surgical care using adult learning concepts. There is also a lecture on obstetrical anesthesia. During the laboratory sessions, learners practice basic surgical, vaginal delivery skills, and caesarean section skills. During the practicum, learners perform six cesarean sections. Participants are certified through The Royal College of Physicians & Surgeons of Canada.


The SOO™ trainings in Uganda took place November 9-16, 2015 and reinstituted ongoing SOO™ trainings in two university teaching hospitals—Mulago and Mbarara. The course also prepared rotating interns (final year medical students) for work in their first two years of medical practice as district health officers.

ACOG worked with Josephat Byamugisha, MD, head of obstetrics and Susan Obore, MD, at the Mulago Hospital. At the Mbarara Hospital, the ACOG team worked with Joseph Ngonzi, MD, head of obstetrics, at the Mbarara Hospital. The training team included Ron Lett, MD, and Jan Christianson, MD, from CNIS; Owen Montgomery, MD, Depak Delvedia, MD, and Gregg Allayne, MD, from Drexel University; and Vineeta Gupta, MD, from ACOG. 

The ACOG team distributed prologues, hysterascopes, and thumb drives with materials from the Global Library of Women’s Medicine and the ACOG Compendium.

Dr. Gupta emphasized the enthusiasm for the trainings, saying “There was a huge hunger for honing surgical skills in residents. And the students were very keen to learn. We were expecting 12 participants, but 19 showed up the first day.”


The result of the trainings is an increased number of in-country SOO™ trainers available for training, mentoring, practicum supervision and verification, as well as increased confidence in trainees to perform cesarean deliveries with fewer complications.

A key part of the Government of Uganda’s Roadmap to Accelerate Reduction of Maternal and Neonatal Mortality and Morbidity is the accomplishment of increased access to caesarean sections and other comprehensive Emergency Obstetrics and Newborn Care (EmONC) services. The project leveraged ACOG’s established coordination with the Uganda Ministry of Health, the USAID mission in Kampala and AOGU (Association for Obstetricians and Gynecologists in Uganda), Drexel University, and ob-gyn faculty in Mulago Hospital and Mbarara University.

About ACOG’s Office of Global Women’s Health

The Office was created to improve women’s health globally through capacity building, collaboration, and health system strengthening. Global Women's Health at ACOG is guided by the Board-appointed Global Operations Advisory Group (GOAG) that includes physicians and educators who are experts in a variety of maternal health issues.

For more information on Structured Operative Obstetrics™ (SOO) trainings, visit the CNIS website. For more information on Drexel University’s Department of Obstetricians and Gynecologists, visit Drexel University’s Department of Ob-Gyn webpage

American College of Obstetricians and Gynecologists
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