Task shifting of emergency caesarean section in south Ethiopia: are we repeating the brain drain.

Anteneh Asefa,Mekonnen Shiferaw,Tadesse Hailemariam,Yifru Birhan,Alison Morgan,Emebet Mekonnen

doi:10.11604/pamj.2020.36.145.19330

Abstract

Introductionpreventable 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.Methodsa 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.Resultsfrom 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).Conclusionour 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.

Highlights

Global maternal mortality declined by 44% between 1990 and 2015, geographical disparities of maternal mortality widened during the same 25-year period [1]
Every training team comprised of either a general practitioner (GP) or health officer (HO) trained as a caesarean section (CS) surgeon, a nurse trained as a scrub nurse and a nurse trained as an anesthetist nurse
From the total number of trained professionals (112), only 52 (6 GPs, 8 HOs, 10 anesthetist nurses and 28 scrub nurses) were active on-site. This means only 27.3% of GPs, 42.1% of HOs, 28.6% of anesthetist nurses and 77.8% of scrub nurses were retained in CS service delivery departments/units of the hospitals

Summary

Introduction

Global maternal mortality declined by 44% between 1990 and 2015, geographical disparities of maternal mortality widened during the same 25-year period [1]. Preventable mortality from complications which arise during pregnancy and childbirth continue to claim more than 250,000 womens lives every year, almost all in low and middle-income countries (LMICs) [1]. To reach the target within the third sustainable development goal (SDG3) of a MMR less than 140 by 2030, the country is prioritizing both the access and quality of maternal health services [3]. In LMICs, improving access to comprehensive emergency obstetric and newborn care (CEmONC) and in particular caesarean sections (CS) is one among several interventions to reduce maternal and newborn mortality [5]. There is a big disparity in rates of CS; rising CS rate due to unjustifiable CSs is becoming a concern, especially in middle and high-income countries [5, 8]

Methods

Results

Discussion

Conclusion