Tanzanian lessons in using non-physician clinicians to scale up comprehensive emergency obstetric care in remote and rural areas

摘要: 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. Considering severe shortage human resources health country, currently operating at 32% required skilled workforce, an intensive three-month course was developed train non-physician clinicians centres. Competency-based curricula assistant medical officers' (AMOs) training CEmOC, nurses, midwives clinical officers anaesthesia operation theatre etiquette were implemented Ifakara, Tanzania. The key competencies identified, taught objectively assessed. involved hands-on sessions, lectures discussions. Participants purposely selected teams from centres where CEmOC planned. Monthly supportive supervision after graduation carried out upgraded A total 43 providers 12 located 11 rural districts 2 Somalia trained June 2009 April 2010. Of 14 AMOs 31 nurse-midwives anaesthesia. During training, participants performed 278 major obstetric surgeries, 141 manual removal placenta evacuation incomplete septic abortions, 1161 anaesthetic procedures under supervision. first 8 months introduction 3 resulted 179 sections, remarkable increase institutional deliveries by up 300%, decreased fresh stillbirth rate (OR: 0.4; 95% CI: 0.1-1.7) reduced referrals 0.2; 0.1-0.4)). There two maternal deaths, both arriving moribund condition. Tanzanian AMOs, officers, can be as team, course, provide effective