Can training in advanced clinical skills in obstetrics, neonatal care and leadership, of non-physician clinicians in Malawi impact on clinical services improvements (the ETATMBA project): A process evaluation

BMJ Open

Volumn 4, Issue 8, 2014, Pages

  Ellard, David R ^a   Chimwaza, Wanangwa ^b   Davies, David ^a   O'Hare, Joseph Paul ^a   Kamwendo, Francis ^b   Quenby, Siobhan ^a   Griffiths, Frances ^a  

^a UNIVERSITY OF WARWICK   (United Kingdom)

^b UNIVERSITY OF MALAWI   (Malawi)

Author keywords

[No Author keywords available]

Indexed keywords

CLINICAL COMPETENCE; EDUCATION; EVALUATION STUDY; FEMALE; HEALTH CARE DELIVERY; HOSPITAL; HUMAN; LEADERSHIP; MALAWI; MATERNAL MORTALITY; MIDWIFE; NEWBORN; OBSTETRICS; PARAMEDICAL PERSONNEL; PERINATAL CARE; PERINATAL DEATH; PHYSICIAN; PREGNANCY; PREVENTION AND CONTROL; PROCEDURES; PROGRAM EVALUATION; QUALITATIVE RESEARCH; STANDARDS; TOTAL QUALITY MANAGEMENT; WORK;

ALLIED HEALTH PERSONNEL; CLINICAL COMPETENCE; DELIVERY OF HEALTH CARE; FEMALE; HOSPITALS; HUMANS; INFANT, NEWBORN; LEADERSHIP; MALAWI; MATERNAL DEATH; MIDWIFERY; OBSTETRICS; PERINATAL CARE; PERINATAL DEATH; PHYSICIANS; PREGNANCY; PROGRAM EVALUATION; QUALITATIVE RESEARCH; QUALITY IMPROVEMENT; WORK;

EID: 84905965889     PISSN: None     EISSN: 20446055     Source Type: Journal    
DOI: 10.1136/bmjopen-2014-005751     Document Type: Article

References (31)

1. WHO. The World Health Report: working together for health. Geneva: World Health Organisation, 2006.
2. Anyangwe SC, Mtonga C. Inequities in the global health workforce: the greatest impediment to health in sub-Saharan Africa. Int J Environ Res Public Health 2007;4:93-100. (Pubitemid 47026512)
3. UNICEF. State of the world's children. New York: United Nations Children and Education Fund, 2009.
4. Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. Lancet 2006;368:1189-200.
5. Lawn JE, Kinney M, Lee AC, et al. Reducing intrapartum-related deaths and disability: can the health system deliver? Int J Gynaecol Obstet 2009;107(Suppl 1):S123-40, S40-2.
6. Bergstrom S. Who will do the caesareans when there is no doctor? Finding creative solutions to the human resource crisis. BJOG 2005;112:1168-9. (Pubitemid 43960908)
7. Chilopora G, Pereira C, Kamwendo F, et al. Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi. Hum Resour Health 2007;5:17.
8. McCord C, Mbaruku G, Pereira C, et al. The quality of emergency obstetrical surgery by assistant medical officers in Tanzanian district hospitals. Health Aff (Millwood) 2009;28:w876-85.
9. Mullan F, Frehywot S. Non-physician clinicians in 47 sub-Saharan African countries. Lancet 2007;370:2158-63. (Pubitemid 350301983)
10. Pereira C, Bugalho A, Bergstrom S, et al. A comparative study of caesarean deliveries by assistant medical officers and obstetricians in Mozambique. Br J Obstet Gynaecol 1996;103:508-12. (Pubitemid 26183167)
11. Pereira C, Cumbi A, Malalane R, et al. Meeting the need for emergency obstetric care in Mozambique: work performance and histories of medical doctors and assistant medical officers trained for surgery. BJOG 2007;114:1530-3. (Pubitemid 350077422)
12. Wilson A, Lissauer D, Thangaratinam S, et al. A comparison of clinical officers with medical doctors on outcomes of caesarean section in the developing world: meta-analysis of controlled studies. BMJ 2011;342:d2600.
13. van Amelsfoort JJC, van Leeuwen PAM, Jiskoot P, et al. Surgery in Malawi-the training of clinical officers. Trop Doct 2010;40:74-6.
14. Wilhelm TJ, Thawe IK, Mwatibu B, et al. Efficacy of major general surgery performed by non-physician clinicians at a central hospital in Malawi. Trop Doct 2011;41:71-5.
15. Bradley S, McAuliffe E. Mid-level providers in emergency obstetric and newborn health care: factors affecting their performance and retention within the Malawian health system. Hum Resour Health 2009;7:14.
16. McAuliffe E, Bowie C, Manafa O, et al. Measuring and managing the work environment of the mid-level provider - the neglected human resource. Hum Resour Health 2009;7:13.
17. WHO. WHO recommendations: optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting. Geneva: World Health Organisation, 2012.
18. Ellard D, Simkiss D, Quenby S, et al. The impact of training non-physician clinicians in Malawi on maternal and perinatal mortality: a cluster randomised controlled evaluation of the enhancing training and appropriate technologies for mothers and babies in Africa (ETATMBA) project. BMC Pregnancy Childbirth 2012;12:116.
19. Ellard D, Parsons S. Process evaluation: understanding how and why interventions work. In: Thorogood M, Coombes Y, eds. Evaluating health promotion practice and methods. 3rd edn. Oxford: Oxford University Press, 2010:87-104.
20. Brennan A-M. ETATMBA: Enhancing human resources and the use of appropriate technologies for maternal and perinatal survival in sub-Saharan Africa. Secondary ETATMBA: Enhancing human resources and the use of appropriate technologies for maternal and perinatal survival in sub-Saharan Africa. [Web Pages] 20 Nov. 2013. http://www2.warwick.ac.uk/fac/med/about/global/etatmba/ about/
21. Ministry of Health. Malawi 2010 EmONC needs assessment final report. Republic of Malawi Ministry of Health, 2011.
22. Steckler A, Linnan L, eds. Process evaluation for public health interventions and research. San Francisco: Jossey-Bass, 2002.
23. Grady K, Ameh C, Adegoke A, et al. Improving essential obstetric and newborn care in resource-poor countries. J Obstet Gynaecol 2011;31:18-23.
24. Labhardt ND, Balo JR, Ndam M, et al. Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: a programme assessment at two years. BMC Health Serv Res 2010;10:339.
25. Wilhelm TJ, Mothes H, Chiwewe D, et al. Gastrointestinal endoscopy in a low budget context: delegating EGD to non-physician clinicians in Malawi can be feasible and safe. Endoscopy 2012;44:174-6.
26. Colbourn T, Nambiar B, Bondo A, et al. Effects of quality improvement in health facilities and community mobilization through women's groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial. Int Health 2013;5:180-95.
27. Colbourn T, Nambiar B, Costello A, et al. Final evaluation report. The impact of quality improvement at health facilities and community mobilisation by women's groups on birth outcomes: an effectiveness study in three districts of Malawi. 2013. http://www.health.org.uk/publications/maikhanda/ (accessed 09/07/2014).
28. Georgeu D, Colvin CJ, Lewin S, et al. Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: a qualitative process evaluation of the STRETCH trial. Implement Sci 2012;7:66.
29. Hargreaves J, Hatcher A, Strange V, et al. Process evaluation of the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) in rural South Africa. Health Educ Res 2010;25:27-40.
30. Ridde V, Diarra A. A process evaluation of user fees abolition for pregnant women and children under five years in two districts in Niger (West Africa). BMC Health Serv Res 2009;9:89.
31. Ronsmans C, Etard JF, Walraven G, et al. Maternal mortality and access to obstetric services in West Africa. Trop Med Int Health 2003;8:940-8. (Pubitemid 37305009)