Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi

Abstract

Background: Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors.

Understanding job satisfaction amongst mid-level cadres in Malawi: the contribution of organisational justice

“…Interestingly, the strongest correlation with job satisfaction on the distributive justice scale occurred with "satisfaction with current work assignments". The fact that mid-level providers who were satisfied with their job assignments were also reporting high levels of job satisfaction provides some evidence that task shifting is not only working in terms of maintaining quality of service, 3,4 but is also having a positive effect on health worker motivation.…”

“…2 In the process, much of the obstetric work traditionally carried out by doctors has been shifted to clinical officers, who perform as much as 93% of major emergency obstetric operations in government hospitals and 78% in mission facilities, with comparable post-operative outcomes. 3,4 Despite these successes, most of the attention in addressing the human resource crisis has focused on increasing the capacity of training institutions to produce more doctors and registered nurses to fill vacancies. In addition there is an assumption that cadres such as enrolled nurses, clinical officers and medical assistants are somehow non-poachable, because they lack internationally recognised qualifications.…”

Task shifting for emergency obstetric surgery in district hospitals in Senegal

“…[22][23][24][25] Several comparative studies pertaining to delegation of skills and responsibilities in the areas of surgery and obstetrics in developed countries (Canada) as well as developing countries (Mozambique and Malawi) have shown no significant difference in quality or safety of clinical outcomes between care provided by specialists and that of non-specialists. [26][27][28] The literature describes this form of resistance as being fuelled by concern over loss of potential earnings and the need to maintain rigid boundaries around professional turf, as well as the belief that it will be detrimental to population health. 25,[29][30][31] .…”

Professional skills development in a resource-poor setting: the case of pharmacy in Malawi

“…There was research evidence about nonprofessional health providers being associated with a higher in-country (and rural) retention rate, cheaper training cost and lower costs for employment (Lehmann et al, 2009;Dovlo, 2004). Furthermore, studies that compared clinical skills between professional and nonprofessional clinicians demonstrated a similar success rate in surgeries carried out by clinical officers, who are technician equivalents to surgeons (Hounton et al, 2009;Chilopora et al, 2007).…”

“…The tendency to micromanage recipient countries would not be removed by signing up to declarations. 8 This new aid modality therefore risks becoming yet another 'toolkit' that may, under certain circumstances, clash with local interests (Colclough et al, 2010).…”