1. Increase clear clinical indication for CS to greater than 90%. 
2. Decrease CS-related maternal complications (e.g. postpartum haemorrhage, infection) and death by more than 30% 
3. Increase WHO Surgical Safety Checklist (SSC) use rate from 0% to greater than 90% 

The project’s goals will be achieved by building capacity, by empowering local surgical teams, and by introducing adapted evidence-based approaches and tools through training and mentorship, which will enhance safe surgical practices and operational performance, particularly regarding timely access to safe, respectful, and appropriate CS in decentralised settings.

The project will apply the innovative “Hub-and-Spoke” model, with training and mentorship initiated and scaled up in one referral hub and three peripheral facilities. This approach will build sustainable capacity building through the development of  a pool of at least ten mentors/trainers (2 interdisciplinary surgical teams) and training at least 50 interdisciplinary surgical team members (obstetricians/surgeons, anaesthesia providers, scrub technicians, nurse, and midwives) to improve the safety and quality of obstetric surgical care for more than 10,000 births that occur annually across the facilities. All facilities will also benefit from key procurement of indispensable surgical supplies needed for safely performing CS.

As an accompaniment with the national professional association through capacity building interventions, a learning agenda as well as a comprehensive monitoring & evaluation framework will generate findings to build evidence of progress and impact, that will be leveraged for transition and scale-up nationally. This will be done in close collaboration with Ministry of Health, the provincial health directorate, health training centre, logistic management centre, public health lab, drug administration office, and 14 health offices in Nepal, in order to inform policies in the Province and nationally. 

This project will adapt a tested innovative model for access to quality obstetric care, building on the success and lessons learned from the implementation in other settings of the model of obstetric safe surgery, optmising maternal care pathways for scaling-up capacity building through an integrated series of key interventions along the continuum. A strong monitoring, evaluation and learning framework will generate key evidence for informing policies and potential scale up of this innovative model for sustainable impact on maternal and newborn health.