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Bognini MS, Oko CI, Kebede MA, Ifeanyichi MI, Singh D, Hargest R, Friebel R. Assessing the impact of anaesthetic and surgical task-shifting globally: a systematic literature review. Health Policy Plan 2023; 38:960-994. [PMID: 37506040 PMCID: PMC10506531 DOI: 10.1093/heapol/czad059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/04/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023] Open
Abstract
The global shortage of skilled anaesthesiologists, surgeons and obstetricians is a leading cause of high unmet surgical need. Although anaesthetic and surgical task-shifting are widely practised to mitigate this barrier, little is known about their safety and efficacy. This systematic review seeks to highlight the existing evidence on the clinical outcomes of patients operated on by non-physicians or non-specialist physicians globally. Relevant articles were identified by searching four databases (MEDLINE, EMBASE, CINAHL and Global Health) in all languages between January 2008 and February 2022. Retrieved documents were screened against pre-specified inclusion and exclusion criteria, and their qualities were appraised critically. Data were extracted by two independent reviewers and findings were synthesized narratively. In total, 40 studies have been included. Thirty-five focus on task-shifting for surgical and obstetric procedures, whereas four studies address anaesthetic task-shifting; one study covers both interventions. The majority are located in sub-Saharan Africa and the USA. Seventy-five per cent present perioperative mortality outcomes and 85% analyse morbidity measures. Evidence from low- and middle-income countries, which primarily concentrates on caesarean sections, hernia repairs and surgical male circumcisions, points to the overall safety of non-surgeons. On the other hand, the literature on surgical task-shifting in high-income countries (HICs) is limited to nine studies analysing tube thoracostomies, neurosurgical procedures, caesarean sections, male circumcisions and basal cell carcinoma excisions. Finally, only five studies pertaining to anaesthetic task-shifting across all country settings answer the research question with conflicting results, making it difficult to draw conclusions on the quality of non-physician anaesthetic care. Overall, it appears that non-specialists can safely perform high-volume, low-complexity operations. Further research is needed to understand the implications of surgical task-shifting in HICs and to better assess the performance of non-specialist anaesthesia providers. Future studies must adopt randomized study designs and include long-term outcome measures to generate high-quality evidence.
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Affiliation(s)
- Maeve S Bognini
- Global Surgery Policy Unit, The London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Christian I Oko
- Division of Health Research, Lancaster University, Bailrigg, Lancaster LA1 4YW, United Kingdom
| | - Meskerem A Kebede
- Global Surgery Policy Unit, The London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Martilord I Ifeanyichi
- Global Surgery Policy Unit, The London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Darshita Singh
- Global Surgery Policy Unit, The London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Rachel Hargest
- Global Surgery Policy Unit, The London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
- University Hospital of Wales, Heath Park, Cardiff CF14 4XN, United Kingdom
| | - Rocco Friebel
- Global Surgery Policy Unit, The London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
- Center for Global Development, Abbey Gardens, Great College Street, London SW1P 3SE, United Kingdom
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Hart MJ, McQuillin SD, Iachini A, Weist MD, Hills KJ, Cooper DK. Expanding School-Based Motivational Interviewing Through Delivery by Paraprofessional Providers: A Preliminary Scoping Review. SCHOOL MENTAL HEALTH 2023; 15:1-19. [PMID: 37359157 PMCID: PMC10039438 DOI: 10.1007/s12310-023-09580-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/28/2023]
Abstract
The supply of school mental health (SMH) providers and services cannot meet the demand of students in-need, and this gap is expected to widen in coming years. One way to increase the reach of helpful services for youth is to grow the SMH workforce through task-shifting to paraprofessionals. Task-shifting could be especially promising in expanding Motivational Interviewing (MI) interventions, as MI can be molded to target a number of academic and behavioral outcomes important to schools. However, no review of training exclusively paraprofessional samples in MI has yet been conducted. The current paper provides a scoping review of 19 studies of training paraprofessional providers to use MI to evaluate trainee characteristics, training content and format, and outcomes. Of these 19 studies, 15 reported that paraprofessionals improved in using MI following training. Nine studies reported that task-shifting MI was positively received by clients and/or providers. Six studies examined task-shifting MI in youth-serving contexts, and four examined the practice in traditional school contexts, suggesting its potential for use in SMH. Other findings and implications, such as client behavior change and provider fidelity, are shared, along with ideas for advancing research, practice, and policy in this subfield.
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Affiliation(s)
- Mackenzie J. Hart
- Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton St., Suite 450, Columbia, South Carolina 29208 USA
| | - Samuel D. McQuillin
- Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton St., Suite 450, Columbia, South Carolina 29208 USA
| | - Aidyn Iachini
- College of Social Work- University of South Carolina, 1512 Pendleton St., Hamilton College Suite 332, Columbia, South Carolina 29208 USA
| | - Mark D. Weist
- Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton St., Suite 450, Columbia, South Carolina 29208 USA
| | - Kimberly J. Hills
- Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton St., Suite 450, Columbia, South Carolina 29208 USA
- Department of Psychology, University of South Carolina, 1331 Elmwood Ave., Suite 140F, Columbia, South Carolina 29201 USA
| | - Daniel K. Cooper
- Department of Psychology, University of South Carolina, Barnwell College, 1512 Pendleton St., Suite 450, Columbia, South Carolina 29208 USA
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Ishikawa M. Current state and future direction of task shifting in obstetric and gynecological care: A survey of obstetrician-gynecologists across Japan. Medicine (Baltimore) 2022; 101:e28467. [PMID: 35029191 PMCID: PMC8758052 DOI: 10.1097/md.0000000000028467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/12/2021] [Indexed: 01/05/2023] Open
Abstract
To conduct a survey about task shifting in obstetric and gynecological care.A multivariate logistic regression analysis was conducted in Japanese hospitals using obstetrician-gynecologists (OB/GYNs) who answered that task shifting was rarely used at their working environment as the outcome variable and using their personal attributes (sex, age, type of medical institution employed at, and regional characteristics) as predictor variables. Opinions were gathered regarding promoting task shifting impact on individual work duties.Responses were collected from 919 OB/GYNs (49.9% women, 50.8% <40 years). Characteristics' analysis of 34.6% of OB/GYNs who thought that task shifting was hardly used indicated that it was used significantly more at private university hospitals (odds ratio 5.33, 95% confidence interval: 2.33-12.18) than at national university hospitals (odds ratio 3.54, 95% confidence interval: 1.67-7.51). "Transfer of patients (from operating rooms to the ward)" and "securing the contrast agent line" were the only items related to the task shifting status for individual work duties that were identified by most respondents, revealing that task shifting is not progressing. More than half and 9% of the OB/GYNs said that task shifting progression would improve and decline medical care quality, respectively. Overall, 46% and 24% of the respondents thought that task shifting could reduce working hours by ">1 hour, but <2 hours"/day and "<1 hour"/day, respectively.The current study confirmed that OB/GYNs working at university hospitals believe that task shifting is not progressing in university hospitals and that the working environment is poor. Even if task shifting reduces the number of working hours per day by 2 hours, the working hours of these physicians still exceed the criteria for death by overwork. Thus, further working hour reduction measures are needed in addition to task shifting, such as consolidation of medical institutions dealing with deliveries.To promote task shifting in obstetrical and gynecological care in Japan, it is necessary to continue promoting policy-based, institutional, and educational guidance.
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Nsemo A, Zakka Malau S, Ojong I. Referral and counter-referral practices in obstetric emergencies among health-care providers in selected health facilities in Plateau state, Nigeria. JOURNAL OF INTEGRATIVE NURSING 2022. [DOI: 10.4103/jin.jin_29_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Mukuru M, Kiwanuka SN, Gibson L, Ssengooba F. Challenges in implementing emergency obstetric care (EmOC) policies: perspectives and behaviours of frontline health workers in Uganda. Health Policy Plan 2021; 36:260-272. [PMID: 33515014 DOI: 10.1093/heapol/czab001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022] Open
Abstract
Uganda is among the sub-Saharan African Countries which continue to experience high preventable maternal mortality due to obstetric emergencies. Several Emergency Obstetric Care (EmOC) policies rolled out have never achieved their intended targets to date. To explore why upstream policy expectations were not achieved at the frontline during the MDG period, we examined the implementation of EmOC policies in Uganda by; exploring the barriers frontline implementers of EmOC policies faced, their coping behaviours and the consequences for maternal health. We conducted a retrospective exploratory qualitative study between March and June 2019 in Luwero, Iganga and Masindi districts selected based on differences in maternal mortality. Data were collected using 8 in-depth interviews with doctors and 17 midwives who provided EmOC services in Uganda's public health facilities during the MDG period. We reviewed two national maternal health policy documents and interviewed two Ministry of Health Officials on referral by participants. Data analysis was guided by the theory of Street-Level Bureaucracy (SLB). Implementation of EmOC was affected by the incompatibility of policies with implementation systems. Street-level bureaucrats were expected to offer to their continuously increasing clients, sometimes presenting late, ideal EmOC services using an incomplete and unreliable package of inputs, supplies, inadequate workforce size and skills mix. To continue performing their duties and prevent services from total collapse, frontline implementers' coping behaviours oftentimes involved improvization leading to delivery of incomplete and inconsistent EmOC service packages. This resulted in unresponsive EmOC services with mothers receiving inadequate interventions sometimes after major delays across different levels of care. We suggest that SLB theory can be enriched by reflecting on the consequences of the coping behaviours of street-level bureaucrats. Future reforms should align policies to implementation contexts and resources for optimal results.
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Affiliation(s)
- Moses Mukuru
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Suzanne N Kiwanuka
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Linda Gibson
- School of Social Sciences, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, UK
| | - Freddie Ssengooba
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
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Naal H, Mendelsohn R, Brome D, Noubani A, Nabulsi D, Muhieddine D, Saleh S. Evaluating a capacity building program on women's health for displaced community health workers in fragile settings in Lebanon. HUMAN RESOURCES FOR HEALTH 2021; 19:37. [PMID: 33743708 PMCID: PMC7981387 DOI: 10.1186/s12960-021-00585-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Displaced populations in fragile settings experience health disparities that are seldom attended to. Task-shifting, which involves training non-specialized community health workers (CHW) to deliver basic education and health services is a favorable strategy to address this problem, however very little data exist on this topic in the Middle East region. We conducted a long-term evaluation of the Women's Health Certificate delivered to Syrian refugees and host community in informal tented settlements in Lebanon under the Mobile University for Health (MUH) program. The training was delivered through a mobile classroom approach that incorporated a blended learning modality. METHODS We collected short-term data from the 42 trained CHW (knowledge assessments and satisfaction measures) during the delivery of the intervention between March and August 2019, and long-term data (semi-structured interviews with 8 CHW and focus group discussion with 9 randomly selected community members) one year later between July and August 2020. The evaluation approach was informed by the Kirkpatrick evaluation model, and the qualitative data were analyzed using qualitative content analysis. RESULTS Data from the CHWs and community members were triangulated, and they showed that the training enhanced access to education due to its mobile nature and provided opportunities for CHWs to engage and interact with learning material that enhanced their knowledge and favorable behaviors regarding women's health. In turn, CHWs were empowered to play an active role in their communities to transfer the knowledge they gained through educating community members and providing women's health services and referrals. Community members benefited from the CHWs and called for the implementation of more similar training programs. CONCLUSION This is one of few studies reporting a long-term community-level evaluation of a task-shifting program on women's health among displaced populations in Lebanon. Our findings support the need to increase funding for similar programs, and to focus on delivering programs for a variety of health challenges. It is also essential to enhance the reach and length of recruitment to wider communities, to design concise, interactive, and engaging sessions, and to provide tools to facilitate circulation of learning material, and resources for referrals to health services.
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Affiliation(s)
- Hady Naal
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Rebecca Mendelsohn
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, USA
| | - Dayana Brome
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Aya Noubani
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dana Nabulsi
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dina Muhieddine
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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Hardhantyo M, Chuang YC. Impact of the Sister Hospital Program on Maternal Mortality and Neonatal Mortality in Nusa Tenggara Timur Province, Indonesia. J Trop Pediatr 2020; 66:487-494. [PMID: 32030431 DOI: 10.1093/tropej/fmaa002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The province of Nusa Tenggara Timur (NTT) in the eastern part of Indonesia is known for high maternal mortality ratios (MMRs) and neonatal mortality eates (NMRs). Sister Hospital is a multicenter program, which aims to lower MMRs and NMRs in the deprived areas of Indonesia by providing comprehensive emergency services for maternal and newborn care. In this study, we evaluated the impact of the Sister Hospital program on MMRs and NMRs in 2009-17. We used linear mixed-effects models to analyze the program's effects. Study results suggested that in general, the Sister Hospital program reduced MMRs by 1.14/100 000 live births after adjusting for other sociodemographic factors. This study also found that the program effects varied by island, and the highest reduction in MMRs, were found on Sumba Island in which the log of MMRs decreased from 2.23 in 2009 to 2.01 in 2017. However, no effects on NMR outcomes by the program were found. These findings suggest that the Sister Hospital program can be a practical solution for lowering MMRs in rural Indonesia.
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Affiliation(s)
- Muhammad Hardhantyo
- School of Public Health, Taipei Medical University, Taipei City 110, Taiwan.,Faculty of Health Science, College of Health Science, Universitas Respati Yogyakarta, Indonesia, Jl. Laksda Adisucipto, Ambarukmo, Caturtunggal, Kec. Depok, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia
| | - Ying-Chih Chuang
- School of Public Health, Taipei Medical University, Taipei City 110, Taiwan
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van Heemskerken P, Broekhuizen H, Gajewski J, Brugha R, Bijlmakers L. Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa-a scoping review. HUMAN RESOURCES FOR HEALTH 2020; 18:51. [PMID: 32680526 PMCID: PMC7368796 DOI: 10.1186/s12960-020-00490-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/07/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) faces the highest burden of disease amenable to surgery while having the lowest surgeon to population ratio in the world. Some 25 SSA countries use surgical task-shifting from physicians to non-physician clinicians (NPCs) as a strategy to increase access to surgery. While many studies have investigated barriers to access to surgical services, there is a dearth of studies that examine the barriers to shifting of surgical tasks to, and the delivery of safe essential surgical care by NPCs, especially in rural areas of SSA. This study aims to identify those barriers and how they vary between surgical disciplines as well as between countries. METHODS We performed a scoping review of articles published between 2000 and 2018, listed in PubMed or Embase. Full-text articles were read by two reviewers to identify barriers to surgical task-shifting. Cited barriers were counted and categorized, partly based on the World Health Organization (WHO) health systems building blocks. RESULTS Sixty-two articles met the inclusion criteria, and 14 clusters of barriers were identified, which were assigned to four main categories: primary outcomes, NPC workforce, regulation, and environment and resources. Malawi, Tanzania, Uganda, and Mozambique had the largest number of articles reporting barriers, with Uganda reporting the largest variety of barriers from empirical studies only. Obstetric and gynaecologic surgery had more articles and cited barriers than other specialties. CONCLUSION A multitude of factors hampers the provision of surgery by NPCs across SSA. The two main issues are surgical pre-requisites and the need for regulatory and professional frameworks to legitimate and control the surgical practice of NPCs.
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Affiliation(s)
| | - Henk Broekhuizen
- Health Evidence Department, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jakub Gajewski
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruairí Brugha
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leon Bijlmakers
- Health Evidence Department, Radboud University Medical Centre, Nijmegen, The Netherlands
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Asefa A, Morgan A, Hailemariam T, Shiferaw M, Mekonnen E, Birhan Y. Task shifting of emergency caesarean section in south Ethiopia: are we repeating the brain drain. Pan Afr Med J 2020; 36:145. [PMID: 32874409 PMCID: PMC7436639 DOI: 10.11604/pamj.2020.36.145.19330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 06/24/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction preventable mortality from complications which arise during pregnancy and childbirth continue to claim more than a quarter of million women´s lives every year, almost all in low- and middle-income countries. However, lifesaving emergency obstetric services, including caesarean section (CS), significantly contribute to prevention of maternal and newborn mortality and morbidity. Between 2009 and 2013, a task shifting intervention to train caesarean section (CS) teams involving 41 CS surgeons, 35 anesthetic nurses and 36 scrub nurses was implemented in 13 hospitals in southern Ethiopia. We report on the attrition rate of those upskilled to provide CS with a focus on the medium-term outcomes and the challenges encountered. Methods a cross-sectional study involving surveys of focal persons and a facility staff audit supplemented with a review of secondary data was conducted in thirteen hospitals. Mean differences were computed to appreciate the difference between numbers of CSs conducted for the six months before and after task shifting commenced. Results from the trained 112 professionals, only 52 (46.4%) were available for carrying out CS in the hospitals. CS surgeons (65.9%) and nurse anesthetists (71.4%) are more likely to have left as compared to scrub nurses (22.2%). Despite the loss of trained staff, there was an increase in the number of CSs performed after the task shifting (mean difference=43.8; 95% CI: 18.3-69.4; p=0.003). Conclusion our study, one of the first to assess the medium-term effects of task shifting highlights the risk of ongoing attrition of well-trained staff and the need to reassess strategies for staff retention.
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Affiliation(s)
- Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Alison Morgan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Mekonnen Shiferaw
- Southern Nations Nationalities and Peoples Regional Health Bureau, Hawassa, Ethiopia
| | - Emebet Mekonnen
- Southern Nations Nationalities and Peoples Regional Health Bureau, Hawassa, Ethiopia
| | - Yifru Birhan
- Federal Ministry of Health, Addis Ababa, Ethiopia
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Holmer H, Kamara MM, Bolkan HA, van Duinen A, Conteh S, Forna F, Hailu B, Hansson SR, Koroma AP, Koroma MM, Liljestrand J, Lonnee H, Sesay S, Hagander L. The rate and perioperative mortality of caesarean section in Sierra Leone. BMJ Glob Health 2019; 4:e001605. [PMID: 31565407 PMCID: PMC6747912 DOI: 10.1136/bmjgh-2019-001605] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/22/2019] [Accepted: 08/03/2019] [Indexed: 11/12/2022] Open
Abstract
Introduction Sierra Leone has the world’s highest maternal mortality, partly due to low access to caesarean section. Limited data are available to guide improvement. In this study, we aimed to analyse the rate and mortality of caesarean sections in the country. Methods We conducted a retrospective study of all caesarean sections and all reported in-facility maternal deaths in Sierra Leone in 2016. All facilities performing caesarean sections were visited. Data on in-facility maternal deaths were retrieved from the Maternal Death Surveillance and Response database. Caesarean section mortality was defined as in-facility perioperative mortality. Results In 2016, there were 7357 caesarean sections in Sierra Leone. This yields a population rate of 2.9% of all live births, a 35% increase from 2012, with district rates ranging from 0.4% to 5.2%. The most common indications for surgery were obstructed labour (42%), hypertensive disorders (25%) and haemorrhage (22%). Ninety-nine deaths occurred during or after caesarean section, and the in-facility perioperative caesarean section mortality rate was 1.5% (median 0.7%, IQR 0–2.2). Haemorrhage was the leading cause of death (73%), and of those who died during or after surgery, 80% had general anaesthesia, 75% received blood transfusion and 22% had a uterine rupture diagnosed. Conclusions The caesarean section rate has increased rapidly in Sierra Leone, but the distribution remains uneven. Caesarean section mortality is high, but there is wide variation. More access to caesarean sections for maternal and neonatal complications is needed in underserved areas, and expansion should be coupled with efforts to limit late presentation, to offer assisted vaginal delivery when indicated and to ensure optimal perioperative care.
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Affiliation(s)
- Hampus Holmer
- Department of Clinical Sciences Lund, WHO Collaborating Centre for Surgery and Public Health, Lund University Faculty of Medicine, Lund, Sweden
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
- Karolinska University Hospital, Solna, Sweden
| | - Michael M Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Håkon Angell Bolkan
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Alex van Duinen
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sulaiman Conteh
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Fatu Forna
- World Health Organization Sierra Leone, Freetown, Sierra Leone
| | - Binyam Hailu
- World Health Organization Sierra Leone, Freetown, Sierra Leone
| | - Stefan R Hansson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Alimamy P Koroma
- Department of Obstetrics and Gynaecology, Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | - Michael M Koroma
- Department of Anaesthesia, Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | - Jerker Liljestrand
- Department of Clinical Sciences Lund, WHO Collaborating Centre for Surgery and Public Health, Lund University Faculty of Medicine, Lund, Sweden
| | - Herman Lonnee
- Department of Anaesthesia, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Santigie Sesay
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Lars Hagander
- Department of Clinical Sciences Lund, WHO Collaborating Centre for Surgery and Public Health, Lund University Faculty of Medicine, Lund, Sweden
- Department of Paediatric Surgery, Skåne University Hospital Children’s Hospital, Lund, Sweden
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Koroma MM, Kamara MA, Keita N, Lokossou VK, Sundufu AJ, Jacobsen KH. Access to Essential Medications and Equipment for Obstetric and Neonatal Primary Care in Bombali District, Sierra Leone. WORLD MEDICAL & HEALTH POLICY 2019. [DOI: 10.1002/wmh3.295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cesarean Section in the Delivery Room: An Exploration of the Viewpoint of Midwives, Anaesthesiologists, and Obstetricians. J Pregnancy 2018; 2018:1017572. [PMID: 30363741 PMCID: PMC6180990 DOI: 10.1155/2018/1017572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 08/19/2018] [Accepted: 09/04/2018] [Indexed: 12/03/2022] Open
Abstract
Aim To explore the attitude and vision of midwives, anaesthesiologists, and obstetricians concerning a dedicated operating room for cesarean sections within the delivery ward versus cesarean sections within the general operating room. Method A descriptive qualitative study using a constructive paradigm. Face-to-face semistructured interviews were performed in 3 different hospitals, one without operating theatre within the delivery ward, one with a recently built cesarean section room within the delivery ward, and one with a long time tradition of cesarean section in the delivery room. Interviews have been analysed thematically. Results Three themes have been identified: organization, role of the midwife, and safety. Although identical protocols for the degree of emergency of a cesarean section are used, infrastructure and daily practice differ between hospitals. Logistic support, medical and midwife staffing, and hospital infrastructure are systematically mentioned as needing improvement. Realizing cesarean section within the delivery ward was considered as an improvement for the patient's experience. Midwives need a clear and new job description and delineation and mention a lack of formal education to assist surgical procedures. To increase patient safety continuous education and communication are considered necessary. Conclusion A detailed job description and education of all those involved in cesarean section at the delivery ward are necessary to improve patient safety. Patient experience is improved, but our knowledge on this is hampered by lack of studies.
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Liu R, Huang L, Yang Q, Hu Q, Huang Q, Jiang X, Zhu H, Xie F, Wen X, Liu X, Yuan Z, Lu Y. Investigation on Task Shifting of HIV/AIDS Follow-Up Management Workers in New Launched Areas, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2132. [PMID: 30274139 PMCID: PMC6210782 DOI: 10.3390/ijerph15102132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/18/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022]
Abstract
Background: This study aimed to understand attitudes of HIV/AIDS follow-up workers regarding task shifting, reveal the current conditions of this implementation, as well as to find out any challenges of early-stage implementation. Methods: Taking Jiangxi Province as an example, a cross-sectional survey with 102 health professionals in CDCs (Centers for Disease Control and Prevention) and 92 health care providers in primary health institutions was conducted from November 2016 to January 2017. This survey includes the demographic backgrounds of participants, their attitudes towards task shifting, and the main difficulties faced in their work, etc. Results: 60.8% of professionals and 77.2% of providers hold positive attitudes towards task shifting. Both health professionals and providers express their concerns about unclear and undefined funds distribution and lack of confidentiality of PLWHA (people living with HIV) in local primary health institutions. Conclusions: The majority of health workers hold positive attitudes towards task shifting. It also highlights some negative reactions in implementation, and reveals the main difficulties that constitute barriers to follow-up. Findings from this study may provide evidence for enhancing future implementation of task shifting.
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Affiliation(s)
- Rong Liu
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China.
| | - Ling Huang
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China.
| | - Qing Yang
- Centers for Disease Control and Prevention of Jiangxi Province, Nanchang 330000, China.
| | - Qiang Hu
- Centers for Disease Control and Prevention of Jiangxi Province, Nanchang 330000, China.
| | - Qing Huang
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China.
| | - Xiaoqing Jiang
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China.
| | - Hui Zhu
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China.
| | - Fei Xie
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China.
| | - Xiaotong Wen
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China.
| | - Xiaojun Liu
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Zhaokang Yuan
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China.
| | - Yuanan Lu
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China.
- Department of Public Health Sciences, University of Hawaii at Mānoa, Honolulu, HI 96822, USA.
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Geelhoed D, de Deus V, Sitoe M, Matsinhe O, Lampião Cardoso MI, Manjate CV, Pinto Matsena PI, Mosse Lazaro C. Improving emergency obstetric care and reversing the underutilisation of vacuum extraction: a qualitative study of implementation in Tete Province, Mozambique. BMC Pregnancy Childbirth 2018; 18:266. [PMID: 29945551 PMCID: PMC6020342 DOI: 10.1186/s12884-018-1901-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/17/2018] [Indexed: 01/29/2023] Open
Abstract
Background Maternal and perinatal mortality in Mozambique were declining at a slow pace, despite progress in coverage of institutional childbirth. Implementation of quality emergency obstetric care including vacuum extraction remained inadequate. In 2015–2017, Tete Province achieved remarkable progress in improving emergency obstetric care and reversing the underutilisation of vacuum extraction, with encouraging results for maternal and perinatal outcomes, despite severe resource constraints. This paper presents the experience of Tete Province, generating a rich, contextualised understanding, which might provide generalizable insights and lessons. Methods This qualitative study design is used to present Tete’s experience in improving emergency obstetric care and reversing the underutilisation of vacuum extraction, drawing on principles from implementation science and applying a systems thinking approach. Sources include routine data, documents, social media messages, and the lived experience of the authors, all intimately involved in the implementation process during 2014–2017. Iterative learning and analysis, involving all authors, led to the final interpretations. Results Within a context of severe resource constraints, Tete applied 4 interventions (training, accreditation, audit, monitoring and evaluation with feedback) to improve the implementation of emergency obstetric care. Considerable progress was achieved in vacuum extraction and other signal functions of emergency obstetric care and in the decision-making process for caesarean sections, contributing to important reductions in the provincial institutional maternal mortality and stillbirth rates. Facilitating factors include attributes of the vacuum extraction itself, of the structural and organisational environments in which it was introduced, of the people involved in implementation, and of the process through which the implementation was rolled-out. Conclusions The lessons from implementation science and systems thinking can contribute to surprising results in the improvement of emergency obstetric care including the use of vacuum extraction, even in a severely resource-constrained setting. The creation of conditions for real change, with empowerment of the staff and managers at the front-line of day-to-day practice in Tete may inspire others in similar conditions and circumstances. The underutilisation of vacuum extraction in middle- and low-income countries is indeed a missed opportunity. Its reversion is possible and provides a good chance to make considerable difference in maternal and perinatal outcomes.
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Affiliation(s)
- D Geelhoed
- Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique.
| | - V de Deus
- Tete Provincial Hospital, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - M Sitoe
- Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - O Matsinhe
- Rural Hospital of Mutarara, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - M I Lampião Cardoso
- Rural Hospital of Ulongue, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - C V Manjate
- District Services of Health, Women and Social Action of Chifunde, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - P I Pinto Matsena
- District Services of Health, Women and Social Action of Cidade de Tete, Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
| | - C Mosse Lazaro
- Tete Provincial Health Directorate, Rua de Macondes, Cidade de Tete, Tete Province, Mozambique
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15
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Mumtaz Z, Patterson P. Does task shifting among parts of a weak health system help? LANCET GLOBAL HEALTH 2018; 5:e734-e735. [PMID: 28716341 DOI: 10.1016/s2214-109x(17)30256-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Zubia Mumtaz
- School of Public Health, University of Alberta, 3-309 Edmonton Clinic Health Academy, 11405-87 Ave Edmonton, AB, Canada.
| | - Patrick Patterson
- School of Public Health, University of Alberta, 3-309 Edmonton Clinic Health Academy, 11405-87 Ave Edmonton, AB, Canada
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16
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Dougherty S, Beaton A, Nascimento BR, Zühlke LJ, Khorsandi M, Wilson N. Prevention and control of rheumatic heart disease: Overcoming core challenges in resource-poor environments. Ann Pediatr Cardiol 2018; 11:68-78. [PMID: 29440834 PMCID: PMC5803981 DOI: 10.4103/apc.apc_135_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rheumatic heart disease (RHD) has long receded as a significant threat to public health in high-income countries. In low-resource settings, however, the specter of RHD remains unabated, as exemplified by recent data from the Global Burden of Diseases Study. There are many complex reasons for this ongoing global disparity, including inadequate data on disease burden, challenges in effective advocacy, ongoing poverty and inequality, and weak health systems, most of which predominantly affect developing nations. In this review, we discuss how each of these acts as a core challenge in RHD prevention and control. We then examine key lessons learnt from successful control programs in the past and highlight resources that have been developed to help create strong national RHD control programs.
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Affiliation(s)
- Scott Dougherty
- Department of Internal Medicine, Ministry of Health, Belau National Hospital, Koror, Republic of Palau
| | - Andrea Beaton
- Children's National Medical Center, Cardiology, Washington DC, USA
| | - Bruno R Nascimento
- Telehealth Center, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, South Africa
| | - Liesl J Zühlke
- Divisions of Paediatric Cardiology and Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Maziar Khorsandi
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nigel Wilson
- Green Lane Paediatic and Congenital Cardiology Department, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics, University of Auckland, Auckland, New Zealand
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17
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Bailey PE, van Roosmalen J, Mola G, Evans C, de Bernis L, Dao B. Assisted vaginal delivery in low and middle income countries: an overview. BJOG 2017; 124:1335-1344. [PMID: 28139878 DOI: 10.1111/1471-0528.14477] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the use of assisted vaginal delivery (AVD) in low- and middle-income countries (LMICs), highlighting what level of care procedures were performed and identifying systemic barriers to its use. DESIGN Cross-sectional health facility assessments. SETTING Up to 40 countries in Latin America, sub-Saharan Africa and Asia. POPULATION Assessments tended to be national in scope and included all hospitals and samples of midlevel facilities in public and private sectors. METHODS Descriptive secondary data analysis. MAIN OUTCOME MEASURES Percentage of facilities where health workers performed AVD in the 3 months prior to the assessment, instrument preference, which health workers performed the procedure, and reasons AVD was not practiced. RESULTS Fewer than 20% of facilities in Latin America reported performing AVD in the last 3 months. In sub-Saharan Africa, 53% of 1728 hospitals had performed AVD but only 6% of nearly 10 000 health centres had done so. It was not uncommon to find <1% of institutional births delivered by AVD. Vacuum extraction appears preferred over forceps. Lack of equipment and trained health workers were the most frequent reasons for non-performance. CONCLUSIONS The low use of AVD in LMICs is in contrast with many high-income countries, where high caesarean rates are also associated with significant rates of AVD. In many LMICs, rising caesarean rates have not been associated with maintenance of skills and practice of AVD. AVD is underused precisely in countries where pregnant women continue to face hardships accessing emergency obstetric care and where caesarean delivery can be relatively unsafe. TWEETABLE ABSTRACT Many LMICs exhibit low use of assisted vaginal delivery where access to EmONC continues to be a hardship.
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Affiliation(s)
- P E Bailey
- Global Health Programs, FHI 360, Durham, NC, USA.,Averting Maternal Death & Disability, Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - J van Roosmalen
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.,Athena Institute, VU University, Amsterdam, The Netherlands
| | - G Mola
- School of Medicine and Health Sciences, Port Moresby General Hospital, Port Moresby, NCD, Papua New Guinea
| | - C Evans
- Global Learning Office, Jhpiego, Baltimore, MD, USA
| | | | - B Dao
- Jhpiego, Baltimore, MD, USA
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18
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Dussault G, Cobb NM. A New Generation of Physicians in Sub-Saharan Africa? Comment on "Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians". Int J Health Policy Manag 2017; 6:57-59. [PMID: 28005544 PMCID: PMC5193509 DOI: 10.15171/ijhpm.2016.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/16/2016] [Indexed: 11/09/2022] Open
Abstract
This commentary follows up on an editorial by Eyal and colleagues in which these authors discuss the implications of the emergence of non-physician clinicians (NPCs) on the health labour market for the education of medical doctors. We generally agree with those authors and we want to stress the importance of clarifying the terminology to describe these practitioners and of defining more formally their scope of practice as prerequisites to identifying the new competencies which physicians need to acquire. We add one new competencies domain, the utilization of new communication technologies, to those listed in the editorial. Finally, we identify policy issues which decision-makers will need to address to make medical education reform work.
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Affiliation(s)
- Gilles Dussault
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nadia M Cobb
- Office for the Promotion of Global Healthcare Equity, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
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19
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Campbell OMR, Calvert C, Testa A, Strehlow M, Benova L, Keyes E, Donnay F, Macleod D, Gabrysch S, Rong L, Ronsmans C, Sadruddin S, Koblinsky M, Bailey P. The scale, scope, coverage, and capability of childbirth care. Lancet 2016; 388:2193-2208. [PMID: 27642023 DOI: 10.1016/s0140-6736(16)31528-8] [Citation(s) in RCA: 191] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/23/2016] [Accepted: 06/17/2016] [Indexed: 12/15/2022]
Abstract
All women should have access to high quality maternity services-but what do we know about the health care available to and used by women? With a focus on low-income and middle-income countries, we present data that policy makers and planners can use to evaluate whether maternal health services are functioning to meet needs of women nationally, and potentially subnationally. We describe configurations of intrapartum care systems, and focus in particular on where, and with whom, deliveries take place. The necessity of ascertaining actual facility capability and providers' skills is highlighted, as is the paucity of information on maternity waiting homes and transport as mechanisms to link women to care. Furthermore, we stress the importance of assessment of routine provision of care (not just emergency care), and contextualise this importance within geographic circumstances (eg, in sparsely-populated regions vs dense urban areas). Although no single model-of-care fits all contexts, we discuss implications of the models we observe, and consider changes that might improve services and accelerate response to future challenges. Areas that need attention include minimisation of overintervention while responding to the changing disease burden. Conceptualisation, systematic measurement, and effective tackling of coverage and configuration challenges to implement high quality, respectful maternal health-care services are key to ensure that every woman can give birth without risk to her life, or that of her baby.
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Affiliation(s)
| | - Clara Calvert
- London School of Hygiene & Tropical Medicine, London, UK
| | - Adrienne Testa
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Lenka Benova
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - France Donnay
- Tulane University School of Public Health, New Orleans, LA, USA
| | - David Macleod
- London School of Hygiene & Tropical Medicine, London, UK
| | - Sabine Gabrysch
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Luo Rong
- National Center for Women and Children Health, Chinese Disease Prevention Control Center, Beijing, China
| | - Carine Ronsmans
- London School of Hygiene & Tropical Medicine, London, UK; West China School of Public Health, Sichuan University, Chengdu, China
| | | | - Marge Koblinsky
- USAID, Office of Health, Infectious Diseases and Nutrition, Maternal and Child Health, Washington, DC, USA
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