Abstract
BackgroundWith 15-30% met need for comprehensive emergency obstetrical care (CEmOC) and a 3% caesarean section rate, Tanzania needs to expand the number of facilities providing these services in more remote areas. Considering severe shortage of human resources for health in the country, currently operating at 32% of the required skilled workforce, an intensive three-month course was developed to train non-physician clinicians for remote health centres.MethodsCompetency-based curricula for assistant medical officers' (AMOs) training in CEmOC, and for nurses, midwives and clinical officers in anaesthesia and operation theatre etiquette were developed and implemented in Ifakara, Tanzania. The required key competencies were identified, taught and objectively assessed. The training involved hands-on sessions, lectures and discussions. Participants were purposely selected in teams from remote health centres where CEmOC services were planned. Monthly supportive supervision after graduation was carried out in the upgraded health centresResultsA total of 43 care providers from 12 health centres located in 11 rural districts in Tanzania and 2 from Somalia were trained from June 2009 to April 2010. Of these 14 were AMOs trained in CEmOC and 31 nurse-midwives and clinical officers trained in anaesthesia. During training, participants performed 278 major obstetric surgeries, 141 manual removal of placenta and evacuation of incomplete and septic abortions, and 1161 anaesthetic procedures under supervision. The first 8 months after introduction of CEmOC services in 3 health centres resulted in 179 caesarean sections, a remarkable increase of institutional deliveries by up to 300%, decreased fresh stillbirth rate (OR: 0.4; 95% CI: 0.1-1.7) and reduced obstetric referrals (OR: 0.2; 95% CI: 0.1-0.4)). There were two maternal deaths, both arriving in a moribund condition.ConclusionsTanzanian AMOs, clinical officers, and nurse-midwives can be trained as a team, in a three-month course, to provide effective CEmOC and anaesthesia in remote health centres.
Highlights
With 15-30% met need for comprehensive emergency obstetrical care (CEmOC) and a 3% caesarean section rate, Tanzania needs to expand the number of facilities providing these services in more remote areas
A total of 14 assistant medical officers (AMOs) were trained in CEmOC and 31 were trained in anaesthesia
Participants were trained in teams from 12 health centres located in Morogoro, Dodoma and Coastal regions, where the funders in collaboration with the respective 11 district health authorities had planned to extend CEmOC services
Summary
With 15-30% met need for comprehensive emergency obstetrical care (CEmOC) and a 3% caesarean section rate, Tanzania needs to expand the number of facilities providing these services in more remote areas. The met need for emergency obstetric care, at 15-30%, and the caesarean section rate (CSR) of 3% are still below ideal levels and constitute the lowest rates in the world [1,3] The majority of these health facility deliveries and caesarean sections are for women in urban areas, where services are more. The Government of Tanzania began training assistant medical officers (AMOs) in the early 1960s These are non-physician clinicians (NPCs) selected from a lesser-trained cadre of clinical officers (COs) for a 2year programme, which includes three months of surgery and three months of obstetrics. They are meant to be general practitioners, but are licensed to perform major surgery independently, including caesarean section. There are only 1600 doctors, mostly concentrated in the biggest cities, 2000 AMOs, 8000 COs and 15,000 nurse-midwives (NM) in the work force in Tanzania, a country with an estimated population of 40 million people [7]
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