The Quality Of Emergency Obstetrical Surgery By Assistant Medical Officers In Tanzanian District Hospitals

Abstract

Five countries in sub-Saharan Africa use nonphysicians to perform major emergency obstetrical surgery. In Tanzania, assistant medical officers provide most of this surgery outside of major cities. Questions about the quality of surgery by nonphysicians have kept most African countries from following this example. We reviewed the records of all patients admitted for complicated deliveries to fourteen district hospitals during four months. Among 1,134 complicated deliveries and 1,072 major obstetrical operations, there were no significant differences between assistant medical officers and medical officers in outcomes, risk indicators, or quality. There were significant differences between mission and government hospitals. I n r e s p o n s e to a c r i t i c a l s h o rtage of health care personnel with clinical skills, twenty-five of forty-seven nations in sub-Saharan Africa have trained and officially authorized nonphysician clinicians to provide clinical services, including writing prescriptions and performing minor surgery. In nineteen countries these clinicians are authorized to provide obstetrical care, but in only five (Ethiopia, Ghana, Malawi, Mozambique, and Tanzania) are they allowed to do cesarean sections and other major emergency obstetrical surgery. A f r i c a n W o r k f o r c e

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