Can training non-physician clinicians/associate clinicians (NPCs/ACs) in emergency obstetric, neonatal care and clinical leadership make a difference to practice and help towards reductions in maternal and neonatal mortality in rural Tanzania? The ETATMBA project

Abstract

ObjectivesDuring late 2010, 36 trainees including 19 assistant medical officers (AMOs) 1 senior clinical officer (CO) and 16 nurse midwives/nurses were recruited from districts across rural Tanzania and invited to join the Enhancing Human Resources and Use of Appropriate Technologies for Maternal and Perinatal Survival in the sub-Saharan Africa (ETATMBA) training programme. The ETATMBA project was training associate clinicians (ACs) as advanced clinical leaders in emergency obstetric care. The trainees returned to health facilities across the country with the hope of being able to apply their new skills and knowledge. The main aim of this study was to explore the impact of the ETATMBA training on health outcomes including maternal and neonatal morbidity and mortality in their facilities. Secondly, to explore the challenges faced in working in these health facilities.DesignThe study is a pre-examination/postexamination of maternal and neonatal health indicators and a survey of health facilities in rural Tanzania. The facilities surveyed were those in which ETATMBA trainees were placed post-training. The maternal and neonatal indicators were collected for 2011 and 2013 and the survey of the facilities was in early 2014.Results16 of 17 facilities were surveyed. Maternal deaths show a non-significant downward trend over the 2 years (282–232 cases/100 000 live births). There were no significant differences in maternal, neonatal and birth complication variables across the time-points. The survey of facilities revealed shortages in key areas and some are a serious concern.ConclusionsThis study represents a snapshot of rural health facilities providing maternal and neonatal care in Tanzania. Enhancing knowledge, practical skills, and clinical leadership of ACs may have a positive impact on health outcomes. However, any impact may be confounded by the significant challenges in delivering a service in terms of resources. Thus, training may be beneficial, but it requires an infrastructure that supports it.

A qualitative process evaluation of training for non-physician clinicians/associate clinicians (NPCs/ACs) in emergency maternal, neonatal care and clinical leadership, impact on clinical services improvements in rural Tanzania: the ETATMBA project

“…20 Evidence from our quantitative study support our positive findings here. 21 In many respects, our findings here match those of the ETATMBA trainees in Malawi. In both cases, the trainees report challenges relating to resources, but there is also some evidence of a positive impact of the training on health outcomes.…”

“…we were like tourists in the theatre, the interns assisted almost all procedures…” Challenges facing the training of Assistant Medical Officers in Tanzania

“…The challenges associated with infrastructure and existence of multiple trainees and thus limited opportunities for practical training as unveiled by this study bring another dilemma in the AMOs training in Tanzania. Although not explicitly the same as what our study has documented, studies from different places in Sub-Saharan Africa reveal inadequacies in the training of the associate clinicians (8,(29)(30)(31)(32). Limited teaching materials as revealed in this study, bring in the challenge of quality of graduates.…”

What benefits do healthcare organisations receive from leadership and management development programmes? A systematic review of the evidence

“…Of these 399, we ultimately included 55 articles that met inclusion criteria. We excluded two articles that focused on leadership training but whose programmes also had a significant focus on clinical skills, which made disaggregating the impacts of the leadership training from the clinical training impossible 16 17. Of these 55 articles, 5 had high relevance, 12 had medium relevance, 30 had low relevance, 2 quantitative articles had null results and 6 articles used qualitative methods relevant for answering our research question.…”