A qualitative process evaluation of training for non-physician clinicians/associate clinicians (NPCs/ACs) in emergency maternal, neonatal care and clinical leadership, impact on clinical services improvements in rural Tanzania: the ETATMBA project

Ellard, David R; Shemdoe, Aloisia; Mazuguni, Festo; Mbaruku, Godfrey; Davies, David; Kihaile, Paul E.; Pemba, Senga; Bergström, Staffan; Nyamtema, Angelo; Mohamed, Hamed-Mahfoudh; O’Hare, J. Paul

doi:10.1136/bmjopen-2015-009000

Cited by 10 publications

(18 citation statements)

References 14 publications

(14 reference statements)

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“…The challenges associated with infrastructure and existence of multiple trainees and thus limited opportunities for practical training as unveiled by this study bring another dilemma in the AMOs training in Tanzania. Although not explicitly the same as what our study has documented, studies from different places in Sub-Saharan Africa reveal inadequacies in the training of the associate clinicians (8,(29)(30)(31)(32). Limited teaching materials as revealed in this study, bring in the challenge of quality of graduates.…”

Section: Discussionsupporting

confidence: 51%

“…we were like tourists in the theatre, the interns assisted almost all procedures…” Challenges facing the training of Assistant Medical Officers in Tanzania

Sirili¹,

Anaeli²,

Mselle³

et al. 2020

Preprint

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Background: Training of mid-level providers is a task sharing strategy that has gained popularity in the recent past for addressing critical shortage of health workforce. In Tanzania, training of mid-level providers has existed for over five decades, however, concerns are upon the quality of the mid-level cadres amidst the growing number of medical universities. This study sought to explore the challenges facing the training of the Assistant Medical Offices in Tanzania.Methods: An exploratory qualitative case study was carried out in four regions to include one rural district in each of the selected regions and two AMOs Training Colleges in Tanzania. A semi-structured interview guide was used to interview 29 Key informants from the district hospitals, district management, regional management, AMOs training college and one retired AMO. In addition, four focus group discussions were conducted with 35 AMO trainees.Results: Training of AMOs in Tanzania faces many challenges. The challenges include; use of outdated and static curriculum, inadequate tutors (lack of teaching skills and experience of teaching adults), Inadequate teaching infrastructure in existence of many other trainees to include interns, and limited or lack of scholarships and sponsorship for the AMO trainees. Conclusions: The findings of this study underscore that the challenges facing AMO training have the potentials to negatively impact the quality of care rendered by this cadre. Holistic approach is needed in addressing these challenges. The solutions should focus on reviewing the curriculum, deploying qualified tutors and improving the competencies of the available tutors through continued medical education programmes. Furthermore, the government in collaboration with other stakeholders should work together to address the challenges on teaching infrastructure and financial support to this cadre that has continued to be the backbone of the primary health care in Tanzania. Long term solution should consider to deploy the medical officers at the primary facilities and phase out the AMOs. Finally, challenges facing mid-level providers in Tanzania and similar settings are similar, thus these findings can be used as a starting pointing in addressing them.

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Section: Discussionsupporting

confidence: 51%

“…we were like tourists in the theatre, the interns assisted almost all procedures…” Challenges facing the training of Assistant Medical Officers in Tanzania

Sirili¹,

Anaeli²,

Mselle³

et al. 2020

Preprint

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“…24 Sadly, in this larger current study, we cannot be certain of this conclusion although our qualitative findings provide some corroboration to our positive findings. 20 It is acknowledged that maternal mortality is still a significant problem, particularly in rural Tanzania. 25 Nelissen et al 25 suggest that there is a great need for the upscaling and use of evidence-based interventions that could help to save lives.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a qualitative study was undertaken time with the trainees and other stakeholders, but this will be reported elsewhere. 20 …”

Section: The Etatmba Project In Tanzaniamentioning

confidence: 99%

Can training non-physician clinicians/associate clinicians (NPCs/ACs) in emergency obstetric, neonatal care and clinical leadership make a difference to practice and help towards reductions in maternal and neonatal mortality in rural Tanzania? The ETATMBA project

et al. 2016

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ObjectivesDuring late 2010, 36 trainees including 19 assistant medical officers (AMOs) 1 senior clinical officer (CO) and 16 nurse midwives/nurses were recruited from districts across rural Tanzania and invited to join the Enhancing Human Resources and Use of Appropriate Technologies for Maternal and Perinatal Survival in the sub-Saharan Africa (ETATMBA) training programme. The ETATMBA project was training associate clinicians (ACs) as advanced clinical leaders in emergency obstetric care. The trainees returned to health facilities across the country with the hope of being able to apply their new skills and knowledge. The main aim of this study was to explore the impact of the ETATMBA training on health outcomes including maternal and neonatal morbidity and mortality in their facilities. Secondly, to explore the challenges faced in working in these health facilities.DesignThe study is a pre-examination/postexamination of maternal and neonatal health indicators and a survey of health facilities in rural Tanzania. The facilities surveyed were those in which ETATMBA trainees were placed post-training. The maternal and neonatal indicators were collected for 2011 and 2013 and the survey of the facilities was in early 2014.Results16 of 17 facilities were surveyed. Maternal deaths show a non-significant downward trend over the 2 years (282–232 cases/100 000 live births). There were no significant differences in maternal, neonatal and birth complication variables across the time-points. The survey of facilities revealed shortages in key areas and some are a serious concern.ConclusionsThis study represents a snapshot of rural health facilities providing maternal and neonatal care in Tanzania. Enhancing knowledge, practical skills, and clinical leadership of ACs may have a positive impact on health outcomes. However, any impact may be confounded by the significant challenges in delivering a service in terms of resources. Thus, training may be beneficial, but it requires an infrastructure that supports it.

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“…Earlier studies have reported barriers to accessing Csections as inadequate skilled human resources (medical doctors, gynaecologists, obstetricians, anaesthetists and midwives), 9,10,11 equipment, 12,13,14 commodities, 15 infrastructure, 11,16 delays in accessing services and failure to follow policies and guidelines on quality of C-section care. 13 Tanzania, with an estimated population of 58.4 million, 17 is one of the top 10 countries that contribute to 58% of the global maternal mortality.…”

Section: Essential Supplies Including Blood and Medicinesmentioning

confidence: 99%

“…However, frequent shortages of necessary equipment and consumables were reported in several studies in Tanzania. 16,42,57,58,59 In situations of severe resource constraints where health facilities are provided with far less equipment and drugs than required, health workers find that they are not able to provide the services expected. 60 Stock-outs of life-saving drugs, blood and resuscitation equipment, known to be critical in serving lives in obstetric emergencies, should be a cause of great concern.…”

Section: Equipment and Essential Suppliesmentioning

confidence: 99%

Capacity for providing caesarean section services in selected health centres and district hospitals in Tanzania

Matinhure¹,

Chimbari²,

Mapunda³

2018

Ghana Medical Journal

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Objective: Tanzania has a high maternal mortality ratio of 556 per 100,000 live births. Timely caesarean sections avert mortality due to life threatening conditions like obstructed labour. This study assessed capacity of selected health facilities to provide caesarean sections in terms of infrastructure, equipment, essential supplies and skill mix. Methods: A cross-sectional mixed methods design was used to include systematic observations using highly structured checklists to determine the adequacy of infrastructure, functional status of equipment, availability of supplies and skill mix. An interview guide and a key-informant interview guide were used to collect data from assistant medical officers and key informants respectively. Descriptive data analysis was conducted using IBM SPSS software package. Results: Deficit for doctors ranged between 3 (37.5%) and 5 (62.5%) per each district hospital. Two out of 3 health centres did not have doctors. Deficit for assistant medical doctors ranged between 10 (62.5%) and 11 (68.8%) per each district hospital. In terms of absolute numbers, assistant medical doctors were more than doctors. Not all facilities had all the equipment, infrastructure or supplies. Challenges cited by most assistant medical officers were; shortage of theatre-trained nurses (91%; n=21), theatres not functioning (61%; n=14), inadequate blood supply (87%; n=20) and inadequate equipment (96%; n=22). Conclusion: Capacity of health facilities to provide caesarean sections was found to be sub-optimal due to health workforce shortages, inadequate infrastructure, equipment and supplies, thus increasing the risk of maternal deaths. These findings are useful in informing strategies to reduce maternal mortality.

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A qualitative process evaluation of training for non-physician clinicians/associate clinicians (NPCs/ACs) in emergency maternal, neonatal care and clinical leadership, impact on clinical services improvements in rural Tanzania: the ETATMBA project

Cited by 10 publications

References 14 publications

“…we were like tourists in the theatre, the interns assisted almost all procedures…” Challenges facing the training of Assistant Medical Officers in Tanzania

“…we were like tourists in the theatre, the interns assisted almost all procedures…” Challenges facing the training of Assistant Medical Officers in Tanzania

Can training non-physician clinicians/associate clinicians (NPCs/ACs) in emergency obstetric, neonatal care and clinical leadership make a difference to practice and help towards reductions in maternal and neonatal mortality in rural Tanzania? The ETATMBA project

Capacity for providing caesarean section services in selected health centres and district hospitals in Tanzania

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