Mid-level Healthcare Providers Research Articles

Primary eye care service provision ability of mid-level healthcare providers in southern Ethiopia

Background: The provision of eye care services by trained and well-capacitated primary care providers in the rural community will contribute significantly to the reduction of avoidable blindness.Aim: This study aimed to investigate mid-level healthcare providers’ knowledge and skills capacity to provide primary eye care services.Setting: The study was conducted in four districts of southern Ethiopia.Methods: An institution-based descriptive cross-sectional study was conducted among randomly selected mid-level healthcare providers from August to October 2023. A self-administered questionnaire was used to collect data. Data entry and analysis were performed using Epi info version 6 and SPSS version 28 software. Descriptive statistics and logistic regression models were used in the analysis.Results: A total of 103 mid-level healthcare providers were involved in the evaluation with a response rate of 99%. Of the study respondents, less than half (48.5%) were found to have intermediate-level ability to provide primary eye care services. Serving more patients per month (p 0.001), receiving additional training (p 0.005) and having a first degree (p 0.001) were found to have a statistically significant association with the ability to provide primary eye care services.Conclusion: Most primary eye care service providers had a significant knowledge and skill gap. Capacity-building training aimed at enhancing the ability of primary eye care service providers need the appropriate attention.Contribution: This study presents the ability of mid-level healthcare workers to provide primary eye care services to support the elimination of avoidable blindness, resulting in improved quality of life.

Mid-level healthcare providers: Making a fresh case for modern Indian healthcare.

To compensate for physician shortage, many countries around the world have introduced a cadre of mid-level healthcare providers (MLHPs) into their health systems to shoulder many of the conventional responsibilities of a physician. Besides backing their clinical competence and service quality, evidence and experience on MLHPs also supports their lower turnover and higher rural retention rates. In India, mainstreaming of MLHPs has time and again been met with resistance from organized medicine. We explore a fresh case for MLHPs in India in view of some recent developments and the probable future contours that Indian healthcare is likely to assume. Aided by global precedents, we broaden the rationale for mainstreaming MLHPs, address some common misunderstandings, and describe the conducive emergent legal and policy landscape. We also explain how a possible reorganization of Indian healthcare, highly likely under expanded publicly financed health insurance and value-based healthcare regimes, can warrant greater health workforce differentiation and an expanded role of MLHPs in mainstream healthcare delivery. We also touch upon important political economy considerations, including the need for navigating organized medical opposition, involving medical stakeholders in the MLHP mainstreaming process, autonomous regulation of MLHP professions, streamlining MLHP competencies, and inclusive health financing systems.

Ensuring excellence: A deep dive into the quality monitoring of Ayushman Bharat health and wellness Centre

This review evaluates the quality monitoring mechanisms of Ayushman Bharat Health and Wellness Centres, integral to India's pursuit of Universal Health Coverage. AB-HWCs are designed to deliver comprehensive primary healthcare, particularly targeting undeserved communities. Despite the significant expansion and progress in healthcare access, the review identifies persistent service quality and infrastructure disparities. The study underscores the necessity of a robust quality monitoring framework, incorporating standardized checklists to ensure consistent and high-quality service delivery. These checklists play a crucial role in systematically assessing the availability of medical supplies, infrastructure adequacy and others, facilitating timely interventions and modification. Additionally, the integration of cultural competence into healthcare delivery is emphasized to enhance the acceptance and effectiveness of services among diverse populations. The review also highlights the critical roles of Community Health Officers and mid-level healthcare providers in the successful operation of HWCs. While acknowledging the commendable progress made by the AB-HWCs initiative, the study concludes that achieving sustainable and equitable health outcomes necessitates ongoing quality monitoring, strategic resource allocation, and adaptive policy measures. The consistent application of checklists in quality assurance processes is essential for maintaining high care standards and advancement of India towards its UHC objectives.

A training program for obstetrics point-of-care ultrasound to rural health care providers in Kenya

Background: Ultrasound is a crucial and effective diagnostic tool in medicine. Recent advancements in technology have led to the increased use of point-of-care ultrasound (POCUS). Access to ultrasound equipment and training programs in low- and middle-income countries (LMICs) is limited. Despite the World Health Organization’s (WHO) recommendations for universal antenatal ultrasounds, POCUS for reproductive health has not been widely used in LMICs. We describe the implementation of obstetrics POCUS training for high-risk conditions in rural public health care facilities in Kenya. Methods: As part of the initiation of a large-scale implementation study of obstetrics-POCUS, clinician trainees were recruited from rural Kenyan hospitals to participate in a series of five-day POCUS workshops. Trainers provided brief didactic lessons followed by hands-on training with live models and at regional clinical sites for five obstetrics POCUS applications. Instructor-observed assessments of students’ scanning and image interpretation were performed during the training period. Assessment of knowledge and confidence was performed via an online pretest and posttest and objective structured clinical examinations. Results: 514 midlevel health care providers were trained over three months, with a trainer: trainee ratio of 1:5. Of the 514 trained HCPs, 468 were from 8 rural counties with poor maternal and neonatal outcomes, while the remaining 46 were from nearby facilities. Obstetrics POCUS topics covered included malpresentation, multiple gestation, fetal cardiac activity, placenta, and amniotic fluid volume. There was a marked improvement in the posttraining test scores. Conclusion: Our implementation description serves as a guide for the successful rapid dissemination of obstetrics POCUS training for midlevel providers. Our experience demonstrates the feasibility of a short intensive POCUS training to rapidly establish specific POCUS skills in efforts to rapidly scale POCUS access and services. There is a widespread need for expanding access to ultrasound during pregnancy through accessible obstetrics POCUS training programs.

A training program for obstetrics point-of-care ultrasound to 514 rural healthcare providers in Kenya

BackgroundUltrasound is a crucial and effective diagnostic tool in medicine. Recent advancements in technology have led to increased use of point-of-care ultrasound (POCUS). Access to ultrasound equipment and training programs in low-and middle-income countries (LMICs) is limited. Despite the World Health Organization (WHO) recommendations for universal antenatal ultrasounds, POCUS for reproductive health applications has not been widely used in LMICs. We describe here the feasibility of implementation of a training of obstetrics point-of-care ultrasound (OB POCUS) for high-risk conditions in rural public healthcare facilities in Kenya with partnership from Butterfly Network, Global Ultrasound Institute, and Kenyatta University.MethodsAs part of the initiation of a large-scale implementation study of OB POCUS, clinician trainees were recruited from rural Kenyan hospitals for participation in a series of five-day POCUS workshops held between September and December 2022. Trainers provided brief didactic lessons followed by hands-on training with live models and at regional clinical sites for 5 OB POCUS applications. Instructor-observed assessment of students’ scanning and image interpretation occurred over the training period. Assessment of knowledge and confidence was performed via an online pre-test and post-test as well as Objective Structured Clinical Examination (OSCE) was administered at course completion.ResultsFive hundred and fourteen mid-level Health Care Providers (HCPs) in Kenya were trained over a three-month period through in-person didactic sessions, bedside instruction, and clinical practice over a 5-day period with a trainer: trainee ratio of approximately 1:5. Out of the 514 trained HCPs, 468 were from 8 rural counties with poor maternal and neonatal outcomes, while the remaining 46 were from nearby facilities. OB POCUS topics covered included: malpresentation, multiple gestation, fetal cardiac activity, abnormalities of the placenta and amniotic fluid volume. There was marked improvement in the post training test scores compared to the pretest scores.ConclusionOur implementation description serves as a guide for successful rapid dissemination of OB POCUS training for mid-level providers. Our experience demonstrates the feasibility of a short intensive POCUS training to rapidly establish specific POCUS skills in efforts to rapidly scale POCUS access and services. There is a widespread need for expanding access to ultrasound in pregnancy through accessible OB POCUS training programs. An implementation study is currently underway to assess the patient and systems-level impact of the training.

Effectiveness of Continued Nursing Education programme on Knowledge regarding concept of Middle Level Health Provider (MLHP) in bridging Health Gap at Peripheral level among Undergraduate Nursing Students of selected Nursing College at Bangalore South, Karnataka, India

The public health system in India was designed with an architectural correction in mind to deliver Primary Health Care. The Indian government has introduced a new position under mid-level healthcare providers: the community health officer. When patients are seeking treatment at HWCs, MLHPs also serve as the primary healthcare providers. Aim: The aim of this study was to determine the effectiveness of Continued Nursing Education Programme on enhancing the Knowledge of Undergraduate Nursing Students on concept of MLHP. Methodology: Quantitative approach with one group Pre-test and Post-test Research Design was used for the study. The Sample Consist of Undergraduate Nursing Students and Non probability purposive sampling technique was used for this study. Study conducted in selected Nursing College of Bangalore. The sample size was 60 Undergraduate Nursing students. Data was gathered through Structured Knowledge Questionnaire on various Concept of MLHP. Result: Post-test Mean percentage knowledge score (Mean percentage =74.28 and SE = 0.341) was found higher than Pre-test Mean percentage knowledge score (Mean percentage = 49.48 and SE = 0.348). Enhancement of Mean Percentage was 24.80%. Conclusion: The study found that Continued Nursing Education Programme was effective in improving the knowledge of undergraduate nursing students on Concept of MLHP. For MLHPs to perform better, they must have access to ongoing training materials.

When a Doctor Falls from the Sky: The Impact of Easing Doctor Supply Constraints on Mortality

This paper describes the results of a policy experiment conducted in coordination with the Nigerian government. In this experiment, some communities were randomly selected to receive a new doctor. These doctors were posted to the local public health center. Prior to their arrival, health care was provided by midlevel health-care providers (MLP). To separate the effect of (ostensibly higher) quality from that of quantity, another group of communities was provided with an additional midlevel provider. A third group of communities received no additional workers. No other inputs were provided. I find a measurable decrease in mortality in communities assigned a doctor but not in communities assigned an MLP, suggesting that quality in the health-care sector is a significant constraint. (JEL I11, I12, O15, O18)

Attrition of dental therapists in South Africa-A 42-year review.

Dental therapists are mid-level oral healthcare providers introduced in 1977 to the South African health system to improve access to oral health services. There has, however, been anecdotal evidence of their unusually high rate of attrition that is cause for concern. This study aimed to determine the demographic profile and attrition rate among members of the South African Dental Therapy profession. A retrospective time series review of records of all dental therapists who were previously registered and who are still registered with the Health Professions Council of South Africa (HPCSA) between 1977 and 2019 was conducted. A total of 1232 dental therapists were registered from 1977 to 2019. The majority (64%) were Africans. Most practicing dental therapists were based in KwaZulu-Natal (44%) and Gauteng (27%), which are the provinces where dental therapists are trained. The overall attrition rate between 1977 and 2019 was 40%, with a figure of 9% for the last 10 years of the study (2010 to 2019). This study has provided the first evidence of the high attrition rate of dental therapists in South Africa. The high attrition warrants further investigation to address the loss of valuable human resources from an already overburdened and under-resourced public oral health sector.

Scope and Future of Mid-Level Health Care Providers (CHOS) at Ab-HWCs in India

There are several countries suffering from short supply of healthcare workers, particularly in villages, it makes difficult to provide essential health care. Low-income of 49 countries to achieve the health MDGs by 2015, an additional 3.5 million health workers are needed. As a developing country, India has a large disease burden and a huge gap in providing medical facilities. There is a need for midlevel health care providers in different settings across the country to provide this service. Government of India has declared new pivotal role of Community Health Officer as part of National Health Mission in order to enable Indian community settings to have access to affordable health care. As outlined in the NMC Bill 2019, nurses will be given the first option as Community Health Officers, which will also facilitate their professional development. Health care access will be promoted through CHOs as a new transforming role. By serving as a MLHP, the CHO will reduce the burden on other health care professionals and also contribute to achieve the aim of “Health for All”. AYUSH and nursing practitioners only qualified candidates for this team in India. Their training and legal authorization limit their ability to provide health care in less cases than physicians, but they have greater access to it than other health care professionals.

Reiterating the Importance of Publicly Funded and Provided Primary Healthcare for Non-communicable Diseases: The Case of India Comment on "Universal Health Coverage for Non-communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare".

India has established health and wellness centres (HWCs) and appointed mid-level healthcare providers (community health officers, CHOs) to provide free and comprehensive primary healthcare (PHC), through screening, prevention, control, management and treatment for non-communicable diseases (NCDs), in addition to existing services for communicable diseases, and reproductive and child health. The range of services being provided and the number of people accessing ambulatory care in these government centres have increased, leading to more equitable healthcare access and financial protection. In policy debates, contestations exist prioritising between PHC or hospital services, and between publicly-provided healthcare or privatised and "purchased" services. Nationally and globally the influence of industries and corporations in health governance has weakened the response against NCDs. PHC initiatives for NCDs must be publicly funded and provided, located within communities, and necessitate action on the determinants of health. The experiences from Australia (a high-income country) and India (a low-and middle-income country) amply illustrate this.

Need-based training of community health officers for tuberculosis care in Ahmednagar district of Maharashtra, India: A before and after study.

BACKGROUND:Community health officers (CHOs) are a newly introduced cadre of mid-level health-care providers who will man the health and wellness centers under Ayushman Bharat Mission in India. Need-based training will help them fulfil their role in early diagnosis, treatment, and referral of tuberculosis (TB) patients. The present study identified the gaps in the awareness about TB in a heterogeneous group of trainees and addressed them through need-based training.MATERIALS AND METHODS:A before and after the study was carried out in 110 trainee CHOs at Rural Medical College, Loni. In-depth interviews were conducted with public health experts and focus group discussion was conducted with trainees to gain the quality inputs. Structured questionnaires based on training objectives specifically pertaining to TB were designed. Training was provided with an emphasis on addressing the gaps identified in the pretest. Posttest evaluation was done at the end of the training to assess its effectiveness. Data were analyzed using the SPSS software version. 17.0 (Inc., Chicago, IL, USA).RESULTS:The mean pretest score was 15.15 (standard deviation [SD] = 3.55) which improved after 6 months training to 24.01 (SD = 1.223), i.e., from 60% to 96%. There was highly significant improvement in overall knowledge score of trainees (t = 28.124, df = 109, P < 0.001). There was a statistically significant improvement in scores of all topics at the end of 6 months training in both Nursing and Ayurved graduates. Except for knowledge regarding the treatment of multidrug-resistant TB (P = 0.004), knowledge about all other topics was comparable in nursing and Ayurved graduates at the end.CONCLUSIONS:Needs assessment proved effective in identifying the gaps in knowledge and skills of interdisciplinary trainee CHOs. Medical colleges with expertise in teaching, training, and health service provision can work with the public health system to provide a model for rapid upgrading and capacity building to meet health-care challenges such as TB.

Health systems challenges and opportunities in tackling non-communicable diseases in rural areas of India.

The increasing burden of non-communicable diseases in rural areas poses new challenges to an already overburdened health systems. We detail these challenges and identify opportunities to address them. The major challenges in service delivery in rural areas include poor accessibility, shortage of adequate manpower especially specialists in rural areas, irregular supply of medicines and lack of adequate diagnostic facilities. This has led to an increased dependency on the private sector resulting in high out-of-pocket and catastrophic health expenditure. The challenges are amplified by lower health literacy, large pool of informal or untrained healthcare practitioners, and lack of proper referral and follow up. The health system opportunities identified include task-shifting by training of mid-level healthcare providers and practitioners from Indian systems of medicine, widening use of e-health and m-health, community engagement and public-private partnerships. Participatory health governance through community engagement has been shown to improve accountability and quality in health systems. Civil society organizations (CSO) can also improve awareness and health-seeking behaviour. New and evidence-based strategies need to be implemented to address health system challenges for tackling non-communicable diseases in rural areas.

Assessment of community-based education in community health officers' training at a Rural Medical College in Northern Ahmednagar District of Maharashtra, India: A longitudinal study.

We evaluated the Community Health Officer (CHO) training program in northern Ahmednagar district of Maharashtra, India. A longitudinal study was conducted among 110 CHO trainees from August 2019 to January 2020. The trainees undertook field visits and survey with lectures and clinical postings. Evaluation was based on pre- and post-Multiple Choice Question tests, the WHO Education of Health Personnel Checklist, Journals, and Logbooks. MannWhitney U-test, Wilcoxon-rank test were used to compare nonnormal variables while t-test was used for comparison of age. Initially, nursing graduates performed better than Ayurveda graduates, especially in punctuality, grasp on problems, and problem-solving ability. Nursing graduates kept better journals and logbooks. Female trainees performed better than male trainees. Ayurveda and nursing graduates were comparable at the end of the training. Need-based training and upskilling of mid-level healthcare providers can be done at scale by roping in medical colleges.

Community health officer: the concept of mid-level health care providers

The concept of mid-level health providers started 100 years ago in many countries and showed a remarkable change in their health indicators. Since last 10 years, the growth of health professionals is in rise with its new emerging roles. Special training with adopted skills is required for mid-level health care providers and the outline roles and responsibilities are already in existence for them. Mid-level health care providers are new emerging workforce in healthcare sector. India is alarming country for disease burden and to cover the huge gap in providing health care facilities, it requires the mid-level health care providers at different settings of the country. Indian community setting is in need to have access of affordable health care and government of India through National Health Mission (NHM) has declare the new pivotal role of community health officer (CHO) with its constructed roles and responsibilities for public health. According to NMC bill 2019, nurses are the first choice for CHO and this will also pave the way for professional development. Since there is global shortage of healthcare professionals and raising need of health care facilities especially in community setting, CHO is new evolving role which will promote the health care in access to community public. CHO being Midlevel health care provider will reduce the burden of other healthcare professionals and also contribute to achieve the aim of ‘health for all’. The aim of this review was to bring a new insight of CHO with its global concept.

Barriers for detection and management of gestational diabetes mellitus in southern Ethiopia: A qualitative study

BackgroundGestational diabetes mellitus (GDM) complicates the health of mother and child not only in the short term but also in the long term basis. Addressing GDM through early detection and proper management is vital to improve maternal and child health. Identifying existing barriers for detection and management is important for policy improvement. This study aims to explore barriers for detection and management of GDM in Wolaita Zone, Southern Ethiopia. MethodsA qualitative study was conducted. Health professionals working in antenatal clinic, delivery, and other maternal health services were selected purposively. A total of 18 in-depth interviews were done. The transcripts were imported into NVIVO version 12 software packages. A qualitative thematic analysis approach was used to analyze the data. ResultsScreening of women for GDM was done based on the risk factor assessment within 24–28 weeks of gestational age. The participants mentioned that they made diagnosis of GDM based on the World Health organization criteria. Barriers for detection and management of GDM include; lack of standard guidelines and protocols, lack of awareness among mid-level health care providers on GDM, inadequate trained health care providers, shortage of supplies and equipment and late antenatal care visits. ConclusionsPolicy makers and health care leadership need to address challenges by availing standard guidelines and protocols, providing on job training for health care providers, fulfilling supplies and consumables and working on early antenatal visits of pregnant mothers.

Medical termination of pregnancy service delivery in the context of decentralization: social and structural influences

BackgroundMedical termination of pregnancy (MToP) is a safe and acceptable abortion option. Depending on country context, MToP can be administered by general practitioners and mid-level healthcare providers in the first and second trimesters of pregnancy. Like other high-income countries, a range of social and structural barriers to MToP service provision exist in Australia. To counter some of these barriers, geographic decentralization of MToP was undertaken in rural Victoria, Australia, through training service providers about MToP to increase service delivery opportunities. The aim of this study was to investigate the factors that enabled and challenged the decentralization process.MethodsFace-to-face and telephone interviews were undertaken between April and June 2016 with a purposeful sample of six training providers and 13 general practitioners (GP) and nurse training participants. Study participants were asked about their perceptions of motivations, enablers and challenges to MToP provision. A published conceptual framework of synergies between decentralization and service delivery was used to analyse the study findings.ResultsThree key themes emerged from the study findings. First, the effort to decentralize MToP was primarily supported by motivations related to making service access more equitable as well as the willingness of training providers to devolve their informal power, in the form of MToP medical expertise, to training participants. Next, the enablers for MToP decentralization included changes in the regulatory environment relating to decriminalization of abortion and availability of required medication, formation of partnerships to deliver training, provision of MToP clinical resources and local collegial support. Finally, challenges to MToP decentralization were few but significant. These included a lack of a state-wide strategy for service provision, provider concerns about coping with service demand, and provider stigma in the form of perceived negative community or collegial attitudes. These were significant enough to create caution for GPs and nurses considering service provision.ConclusionsDecentralization concepts offer an innovative way for reframing and tackling issues associated with improving MToP service delivery. There is scope for more research about MToP decentralization in other country contexts. These findings are important for informing future rural MToP service expansion efforts that improve equity in service access.

Provision of medical abortion by midlevel healthcare providers in Kyrgyzstan: testing an intervention to expand safe abortion services to underserved rural and periurban areas

ObjectiveTo demonstrate the feasibility and safety of training midlevel healthcare providers (midwives and family nurses) to provide medical abortion and postabortion contraception in underserved areas in Kyrgyzstan. Study designThis was an implementation study at four referral facilities and 28 Felsher Obstetric Points in two districts to train their midwives and family nurses to deliver safe and effective abortion care with co-packaged mifepristone–misoprostol and provide contraceptives postabortion. The outcome of abortion — complete abortion, incomplete abortion or o-going pregnancy — was the primary end point measured. An international consultant trained 18 midwives and 14 family nurses (with midwifery diplomas) to provide medical abortion care. Supervising gynecologists based in the referral centers and study investigators based in Bishkek provided monthly monitoring of services and collection of patient management forms. A voluntary self-administered questionnaire at the follow-up visit documented women's acceptability of medical abortion services. All study data were cross-checked and entered into an online data management system for descriptive analysis. ResultsBetween August 2014 and September 2015, midwives provided medical abortion to 554 women with a complete abortion rate of 97.8%, of whom 62% chose to use misoprostol at home. No women were lost to follow-up. Nearly all women (99.5%) chose a contraceptive method postabortion; 61% of women receiving services completed the acceptability form, of whom more than 99% indicated a high level of satisfaction with the service and would recommend it to a friend. ConclusionThis study demonstrates that trained Kyrgyz midwives and nurses can provide medical abortion safely and effectively. This locally generated evidence can be used by the Kyrgyz Ministry of Health to reduce unintended pregnancy and expand safe abortion care to women in underserved periurban and rural settings. ImplicationsSuccess in scaling up midwife/nurse provision of medical abortion in Kyrgyzstan will require registration of mifepristone–misoprostol, regulations permanently allowing midwife/nurse provision, strengthened procurement and distribution systems to prevent stockouts of supplies, preservice training of midwives/nurses and their involvement in district level supervision, monitoring and reporting, and support from supervisors.

Clinical training and trainee follow-up systems to improve access to long-acting reversible contraception in conflict settings

Abstract Background Long-acting contraceptive methods (LARC)—intra-uterine device (IUDs) and contraceptive implants—are highly effective in the prevention of unintended pregnancy. However, access to LARC is limited, especially in developing countries where access is dependent on availability of medical doctors and midwives. Pre-service training for nurses does not usually include counselling about LARC methods, or insertion and removal of IUDs and implants. We aimed to improve access and availability of LARC in North Kivu, Democratic Republic of the Congo, by implementing a clinical training programme for nurses who had clinical experience in the public health system. The programme was implemented in collaboration with the Ministry of Health. The purpose of the programme was to increase access to all modern contraceptive methods, including LARC, at health centre level and to improve nurses' clinical skills in family planning counselling and insertion and removal of IUDs and implants. Methods From July, 2011, we delivered contraceptive commodities, installed data collection systems, and obtained approval to train nurses and midwives (mid-level health-care providers). Seventy-one nurses and midwives received competency-based clinical training for 3 weeks at a district hospital in Goma. The training curricula included counselling, practicum on anatomical models, and, finally, service provision to clients under observation and supervision by facilitators. Facilitators were mostly Congolese medical doctors who had received the 3-week clinical training and a certification on how to facilitate clinical trainings (trainers of training) at a centre managed by Marie Stopes Society in Kenya. Each health-care provider received trainee follow up, mentoring, and frequent supportive supervision by clinical supervisors throughout the implementation period. The programme was monitored via a monthly review of client data, supportive supervision reports, client exit interviews, and provider log books. Findings From January, 2012, to December, 2013, the number of clients seeking modern contraceptive methods increased by 54% (from 8301 in 2012 to 12 830 in 2013). The percent change of clients seeking IUDs was 127% (from 440 to 999) and the number of clients who had contraceptive implants increased by 46% (from 5124 to 7499). Client exit interviews of 415 women at 23 clinics showed a satisfaction rate of 80–90%. Interpretation Competency-based clinical training is feasible in a conflict setting such as the Democratic Republic of the Congo, and can be effective in improving provider skills and availability and use of LARC. Attention to the partnership with the Ministry of Health and establishment of clinical training centres at the start of the programme were crucial for success. Funding Donation from an anonymous private foundation that does not have commercial interests in the study topic. The donor did not participate in the design of the study, data analysis, or the interpretation of findings.

380 The Effects of Cardiac Arrest Simulation on Health Care Providers’ Adherence to Advanced Cardiac Life Support Algorithms and Individual Group/Perceived Performance

380 The Effects of Cardiac Arrest Simulation on Health Care Providers’ Adherence to Advanced Cardiac Life Support Algorithms and Individual Group/Perceived Performance

Preventive lipostasis: spawning lipochondria.

In India, the 1971 Medical Termination of Pregnancy Act, while allowing abortions under a broad range of circumstances, can be considered a conservative law from a feminist perspective. The Act allows healthcare providers rather than women seeking abortion to have the final say on abortion, and creates an environment within which women are made dependent on their healthcare providers. On October 29, 2014, the Ministry of Health and Family Welfare released a draft of the MTP (Amendment) Bill 2014 (1), which proposes changes that could initiate a shift in the focus of the Indian abortion discourse from healthcare providers to women. Such a shift would decrease the vulnerability of women within the clinical setting and free them from subjective interpretations of the law. The Bill also expands the base of healthcare providers by including mid-level and non-allopathic healthcare providers. While the medical community has resisted this inclusion, the author is in favour of it, arguing that in the face of the high rates of unsafe abortion, such a step is both ethical and necessary. Additionally, the clause extending the gestational limit could trigger ethical debates on eugenic abortions and sex- selective abortions. This paper argues that neither of these should be used to limit access to late-trimester termination, and should, instead, be dealt with separately and in a way that enquires into why such pregnancies are considered unwanted. On October 29, 2014 the Ministry of Health and Family Welfare (MOHFW) released a draft of the Medical Termination of Pregnancy (Amendment) Bill (1), which proposes to improve access to abortion through steps that will expand the healthcare providers’ base and simultaneously reduce women’s dependency on healthcare providers during the process of seeking abortion. The Bill proposes to train and allow non- allopathic and mid-level healthcare providers to perform abortions. It also outlines the methods of abortion more MTP Amendment Bill, 2014: towards re-imagining abortion care