Expected to deliver: Alignment of regulation, training, and actual performance of emergency obstetric care providers in Malawi and Tanzania

Abstract

a b s t r a c t a r t i c l e i n f oObjective: Policy, regulation, training, and support for cadres adopting tasks and roles outside their historical domain have lagged behind the practical shift in service-delivery on the ground. The Health Systems Strengthening for Equity (HSSE) project sought to assess the alignment between national policy and regulation, preservice training, district level expectations, and clinical practice of cadres providing some or all components of emergency obstetric care (EmOC) in Malawi and Tanzania. Methods: A mixed methods approach was used, including key informant interviews, a survey of District Health Management Teams, and a survey of health providers employed at a representative sample of health facilities. Results: A lack of alignment between national policy and regulation, training, and clinical practice was observed in both countries, particularly for cadres with less preservice training; a closer alignment was found between district level expectations and reported clinical practice. There is ineffective use of cadres that are trained and authorized to provide EmOC, but who are not delivering care, especially assisted vaginal delivery. Conclusion: Better alignment between policy and practice, and support and training, and more efficient utilization of clinical staff are needed to achieve the quality health care for which the Malawian and Tanzanian health ministries and governments are accountable.

Bypassing primary care clinics for childbirth: a cross-sectional study in the Pwani region, United Republic of Tanzania

“…Other studies have similarly documented better quality of care in hospitals versus lower-level facilities. 15,29 A strength of this study was the availability of objective data on the quality of the structure and process of care in the primary care facilities. We found that recent facility upgrades in a woman's catchment clinic reduced her probability of bypassing and that the number of basic emergency obstetric services performed in the clinic in the previous three months was a strong and consistent predictor of women's behaviour.…”

“…Bypassing primary clinics for childbirth in the United Republic of Tanzania Margaret E Kruk et al 15 In addition, each administrative division has health centres with inpatient services that serve from 6000 to 10 000 people and are staffed by nurses and assistant medical officers. Each district has at least one district hospital staffed by a few physicians and with an operating theatre.…”

Investigating Preterm Care at the Facility Level: Stakeholder Qualitative Study in Central and Southern Malawi

“…lack of equipment, supplies and drugs, outdated clinical protocols and staff shortages) [8]. To help parents and health professionals in the management of preterm births, various guidelines have been developed and approved by many scientific societies in various countries [9].…”

What elements of the work environment are most responsible for health worker dissatisfaction in rural primary care clinics in Tanzania?

“…Nurses have completed 4 years of secondary school and a subsequent 3 years of professional training. Medical attendants have the least training: they are generally primary school leavers (7 years of education) who receive 1 year of basic nursing training [16,17]. These primary care clinics (dispensaries) create the cornerstone of the healthcare system, however, they tend to be under-staffed and under-resourced [18].…”