Emergency obstetric care: Making the impossible possible through task shifting

Abstract

a b s t r a c t a r t i c l e i n f o Keywords:Cesarean delivery Emergency obstetric care Maternal mortality Nonphysician clinician Task shifting Task shifting-moving tasks to healthcare workers with a shorter training-for emergency obstetric care (EmOC) can potentially improve access to lifesaving interventions and thereby contribute to reducing maternal and neonatal morbidity and mortality. The present paper reviews studies on task shifting for the provision of EmOC. Most studies were performed in Sub-Saharan Africa and South Asia and focused primarily on task shifting for the performance of cesarean deliveries. Cesarean delivery rates increased following EmOC training without significant increase in adverse outcomes. The paper discusses the advantages and disadvantages of task shifting in EmOC and the role of this approach in improving maternal and newborn health in the short and long term.

Assisted vaginal delivery in low and middle income countries: an overview

“…Specialists were reported frequently as providers of AVD in hospitals as were midwives, whereas midwives were clearly the most prevalent providers at non‐hospitals. Mozambique exemplifies a country where facilities were staffed with midwives trained to perform vacuum extraction, and reflects the government's successful task‐sharing strategy for providing obstetric care …”

“…The most controversial signal function is AVD, where the debate centres on different issues: a concern from some specialists and policy makers who question its safety at a health centre with no immediate access to surgical backup; and from programme managers and evaluators, who sometimes redefine B‐EmOC by dropping AVD as a signal function because it is frequently missing. To answer the first set of critics, we do not have the rigorous evidence for task‐shifting AVD as we do for caesarean deliveries performed by associate clinicians . The research community could provide the evidence that midwives can perform vacuum extraction as safely and effectively as doctors, as well as determine the costs and benefits of performing AVD at the health‐centre level.…”

Correlation of Obstetric Care Facility Density with Standard Emergency Obstetric and Neonatal Care Indicators in Tanzania Mainland

“…Field data were collected using a standard EmONC data collection tool which was modified to include locally relevant indicators [10]. The EmONC tool has been extensively used to collect such data and is internationally accepted [8,10,[15][16][17][18]. All field data were directly entered in an electronic tool and promptly sent online along with the facility's Global Positioning System (GPS) location.…”

A New Generation of Physicians in Sub-Saharan Africa? Comment on "Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians"

“…4-7 Schneeberger and Mathai note that in Mozambique the assistant medical officers (AMOs) are ‘essential to provide life-saving surgical services in rural areas,’ which in turn decreases unnecessary referrals, decreases delay in care, decreases the workload at referral hospitals, and ultimately costs. 5 They also note that on average physicians leave their rural postings within 3 years, but 88% of AMO’s stayed more than 7 years. 5 In this commentary on the discussion by Eyal et al of the impact of the emergence of NPCs in the health labour market on the practice of medicine, we raise questions that need further exploration and discuss the policy implications of reforming medical education.…”

“…5 They also note that on average physicians leave their rural postings within 3 years, but 88% of AMO’s stayed more than 7 years. 5 In this commentary on the discussion by Eyal et al of the impact of the emergence of NPCs in the health labour market on the practice of medicine, we raise questions that need further exploration and discuss the policy implications of reforming medical education. …”