A pilot study between 1991 and 1993 was conducted in district, regional and tertiary hospitals in the Western and Eastern Cape and Gauteng Provinces of South Africa. In all sites, the theoretical knowledge of maternal and newborn care improved significantly (p<0,01) when PEP was used by groups of midwives to manage their own training courses.

Professor Gerhard Theron (Head, Department of Obstetrics and Gynaecology, University of Stellenbosch) introduced the Maternal Care book to midwives in Grahamstown. The midwives managed their own course. The neighbouring towns of Cradock and Somerset East were used as control sites where the book was not used. The knowledge, clinical skills, attitudes and standard of patient care of the midwives in both the study and control towns were formally assessed at the start and end of the trial. Theoretical knowledge, practical skills, attitudes and patient care practices improved significantly in the intervention towns (p<0,01) but not in the control towns.

Dr David Greenfield (School of Child and Adolescent Health, University of Cape Town) conducted a similarly designed study using the Newborn Care book at the Uitenhage Provincial Hospital. He showed that neonatal nurses in the study hospital significantly (p<0,01) improved their knowledge, clinical skills and patient care practices.

The Perinatal HIV book was assessed in a small field trail in Kwazulu/Natal. This study documented a significant (p<0,01) improvement in theoretical knowledge when midwives managed their own courses.

Most participants reported that they found this learning method simple, easy and enjoyable. They felt more confident of their knowledge and skills, less stressed at work and happier that they were providing a better service to their patients. Many nurses expressed a wish that their medical colleagues should also use the PEP books. Medical students have also enjoyed the PEP books, which have helped prepare them for community service.