SAFE Obstetrics in Nepal has grown through local leadership and partnerships, reaching the clinicians who need it most and supporting maternal and newborn care in low-resource settings.
In Nepal, access to safe obstetric anaesthesia is limited by geography, workforce shortages, and resources, especially in rural hospitals. Many areas still rely on non-physician anaesthesia professionals, making high-quality training essential.
Safer Anaesthesia From Education (SAFE) Obstetrics, first introduced in 2017 with WFSA’s support, is now led by the Nick Simons Institute (NSI) and the National Academy of Medical Sciences (NAMS). Delivered at the National Simulation Lab, Bir Hospital, it strengthens practical skills, clinical confidence, and team-based care. Since its launch, NSI and NAMS have run seven courses, training 167 participants including anaesthesia assistants, general practitioners, and anaesthesiologists.
Arpana BC Kalaunee, Training Manager at NSI, and Sajani Shakya, Administrative Officer, talk about the journey of SAFE Obstetrics in Nepal, how it adapts to local realities, and its impact on maternal and newborn care.
1. What are the challenges in Anaesthesiology in Nepal?
Anaesthesiologists, general practitioners, and anaesthesia assistants are now in many rural areas, but anaesthesiologists remain limited. In peripheral hospitals, anaesthesia assistants are often the only anaesthesia staff, and if unavailable, surgeries can stop. For example, a recent case in Koshi Province required a helicopter referral for a pregnant woman due to the absence of a practitioner. Hospitals have suggested having two practitioners per site to maintain services.
Research shows the crucial role of anaesthesia assistants in maintaining surgical services in rural Nepal. You can read more in this study on anaesthesia workforce challenges in Nepal.
2. How did you become involve with SAFE Obstetrics courses?
I (Arpana BC Kalaunee) lead NSI’s training component, coordinating programmes and developing sites and trainers, while supporting the government to deliver courses. Our work focuses on logistics, technical support, budgeting, coordination, and quality assurance.
Anaesthesia has long been a challenge in Nepal. Twenty years ago, anaesthesiologists were rare, especially in rural areas. National Health Training Centre trained anaesthesia assistants, initially for six months, later extended to a year with NSI and NAMS support. Around the same time, SAFE Obstetrics was introduced as a refresher to strengthen those practitioners’ skills in safe obstetric care.
3. How does NSI work with the Society of Anaesthesiologists of Nepal (SAN) in delivering SAFE Obstetrics training?
With the support of Dr Amir Babu Shrestha, former President of SAN, and other SAN members at NAMS, NSI was connected with WFSA and introduced to the SAFE courses. This led to the launch of SAFE Obstetrics in Nepal in 2017 with WFSA funding, with NSI involved through its work with anaesthesia assistants.
Today, SAFE Obstetrics is jointly led by NSI and NAMS, and all course trainers are members of SAN. The first cohorts were delivered at NSI with WFSA trainers. Since then, NAMS and NSI have run at least one course each year, adding Training of Trainers (ToT) as needed. Following COVID, the establishment of a simulation lab at NAMS strengthened equipment and teaching, supporting the programme’s continued growth.
4. Who usually attends SAFE Obstetrics courses?
SAFE Obstetrics mainly refreshes anaesthesia assistants after their one-year training. Most work in peripheral hospitals, some in tertiary centres. Each 24-participant course also includes general practitioners and anaesthesiologists, with a few trained as future course trainers.
NSI tracks participants in the field, sees clear skill improvements, and shares strong case studies during sessions. Health workers often ask when the next course will run, and past participants frequently express interest in joining again.
5. How are participants selected and what does a typical course look like?
Participants are chosen based on where they work. Rural general practitioners in hospitals with active surgical services are prioritised, while urban anaesthesiologists are selected to develop as future trainers.
SAFE Obstetrics courses are led by anaesthesiologists and run for three days. Each day begins with 30–45 minutes of theory, followed by intensive hands-on skills training using simulation props. Daily feedback refines the course and trainers’ delivery. Trainers for these courses are the product of the SAFE ToT Course, often drawn from early SAFE cohorts. WFSA provides updated materials and a reporting system for all trainings.
Participants respond very positively to the emergency management component of SAFE. They value the course because it goes beyond theory and places strong emphasis on hands-on, practical skills, which are directly relevant to managing obstetric emergencies.
All participants receive printed SAFE handbooks and course manuals, which they continue to use as a practical reference after the course whenever questions or uncertainties arise.
6. What are your plans for expanding or continuing SAFE Obstetrics training in Nepal?
SAFE runs in five-year project cycles. After reviewing its impact, we’ve decided to continue SAFE Obstetrics in Nepal for the next five years, as it remains one of our most effective programmes.
7. What is the impact of SAFE on maternal and newborn care?
SAFE is crucial for improving maternal and newborn care. While maternal mortality has declined in Nepal, newborn mortality remains high. The course directly addresses both maternal and newborn emergencies. Working closely with the government, stakeholders concluded that SAFE Obstetrics should continue for at least the next five years.
8. What has been the most rewarding aspect of running SAFE Obstetrics courses?
The most rewarding part is seeing the programme’s impact. Participants share stories of using their skills in remote settings to save lives, which is deeply motivating and reinforces the value of SAFE Obstetrics.
One trainee shared an early-career experience where a patient developed anaphylaxis before a C-section. Using skills from SAFE Obstetrics, she acted quickly, stopping the drug, giving oxygen and adrenaline, and preparing airway equipment. The patient stabilized, spinal anaesthesia was completed safely, and both mother and baby were fine. The trainee said the experience showed how the course’s practical training can save lives.
For more on the global SAFE initiative and how this training strengthens anaesthesia skills in low-resource settings, visit the WFSA SAFE training page.
