1 / 25

TRAINING NON-PHYSICIAN CLINICIANS TO

TRAINING NON-PHYSICIAN CLINICIANS TO IMPROVE THE SURVIVAL OF MOTHERS AND BABIES IN AFRICA – THE ETATMBA PROJECT . DR PAUL O’HARE PROJECT LEAD. ETATMBA: (Enhancing Training and Appropriate Technologies for Mothers and Babies in Africa).

kael
Download Presentation

TRAINING NON-PHYSICIAN CLINICIANS TO

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. TRAINING NON-PHYSICIAN CLINICIANS TO IMPROVE THE SURVIVAL OF MOTHERS AND BABIES IN AFRICA – THE ETATMBA PROJECT DR PAUL O’HARE PROJECT LEAD

  2. ETATMBA: (Enhancing Training and Appropriate Technologies for Mothers and Babies in Africa) • ETATMBA is a European Commission FP7 funded project being delivered in Tanzania and Malawi • Partners: • The University of Warwick (UK) • Karolinska Institute (Sweden) • Ifakara Health Institute, Tanzania • The University of Malawi • The Ministry of Health (Malawi) • GE Healthcare (UK)

  3. 600,000 women and 7 million babies die annually in childbirth. • When obstetric and neonatal emergencies arise most Sub-Saharan African women face childbirth without access to skilled health workers. • Education, training and retention of health professionals is the key to improving healthcare for mothers and babies in Africa. • In the modern world this tragedy is unacceptable and largely preventable.

  4. ETATMBA (Enhancing Training and Appropriate Technologies for Mothers and Babies in Africa) • Very few Medical Doctors in Malawi and Tanzania • 260* approximately 1 Medical Doctor per 50,000 people Similar to other African Countries much of this work is done by: • Non-Physician Clinicians (NPCs) *Data from 2009

  5. Non-Physician Clinicians • (NPCs) are an effective and retainable health solution for doctor-less rural and many urban areas of Africa. • Task-shifting to NPCs needs to be: extended enhanced endorsed and supported by the healthcare community. • Karolinska (S.B.), global health lead in advocating and evaluating NPCs. • Needs to be developed, scaled up and be sustainable in an African setting. • Warwick expertise in scaling up health professional educational delivery.

  6. Peirera & Bergström • 2071 Caesarean Sections • - Non-Clinician Physicians • - Doctors in District hospitals (Medical Officers) • No clinically significant difference in outcome • Mozambique 2002 – NPCs (TCs) performed 57% of 12000 caesarean section • ruptured uterus • ectopic pregnancy • Rural areas 92% of 3246

  7. Retention of DRs in Africa • ‘There are more Malawi doctors in Manchester than Malawi’ • Newly graduated Malawi doctors are sent to district/rural posts but none remain in these posts after 7 years. • 88% of NPCs (TC) are retained in their original post • But • Professional Status • Continuing Professional Development • Maintenance and progression of standards • Sustainability of resource • Training in leadership in Health

  8. Non-Physician Clinicians (NPC’s) • “The crisis in human healthcare resources disproportionately affects the poorest women in low income countries.” • “Are non-physician clinicians a substandard solution to the crisis in human resources for maternal health?” • “Evidence suggests that the answer is no.” Bergström, BMJ 2011;342:d2499 doi: 10.1136/bmj.d2499

  9. “The Warm Heart of Africa”

  10. Facts about Malawi (General) • Malawi is 45.7472 miles (118.4832 km) in size England is 50.3462 miles (130.3952 km) • Malawi (formally Nyasaland)Was a British Colony until 1964 Lake Malawi (Lake Nyasa) 3rd largest in Africa 8th in world Main language is English (and they drive on the left!) • Population is currently about 15 Million Predicted to rise to 45 Million by 2050 • 80% are Christian and about 13% Muslim • Education: Entitled to 5 years primary education (not compulsory) Uptake is low but improving • A resource poor country (some tobacco, sugar, tea etc…) Agriculture, Subsistence farming (Maize being main crop)

  11. Main Health Issues Life expectancy at birth: • Total population: 51.7 years • Male: 50.93 years • Female: 52.48 years • HIV/AIDS • WHO suggest 13% of population but data from 2007 (Just under 1 Million people living with HIV/AIDS) • Malaria • Maternal and Neonatal Mortality • (2011 estimates WHO)

  12. Healthcare Spend Per Capita (USD) USA, $7,410* UK, $3,399* Malawi, $50* *Source: WHO (Global Health Observatory, 2009)

  13. ETATMBA • The project is to train 50 Non-Physician Clinicians (NPCs) as advanced leaders providing them with skills and knowledge in advanced neonatal and obstetric care (over a 24 month period). • Training it is hoped that will be cascaded to their colleagues (other NPCs, midwives, nurses). • The aim of the project is to try and address the high levels of maternal and neonatal mortality.

  14. Clinical Service Improvement will be developed, implemented and evaluated through: • clinical guidelines and pathways, • structured education, • clinical leadership training and • workforce development of NPCs and faculty.

  15. Evaluating the impact of ETATMBA • The aim of this study is to: • Evaluate the impact on healthcare outcomes of the ETATMBA training in Malawi. • OUTCOMES (Primary): • Perinatal mortality (defined as fresh stillbirths and neonatal deaths before discharge from the health care facility) • OUTCOMES (Secondary): • Maternal death rates; • Recorded data (e.g. still births, Post-Partum Haemorrhage, C Section, Eclampsia, Sepsis, • Neonatal resuscitation); • Availability of resources (e.g. are drugs/blood available); • Use of available resources (e.g. are drugs being used).

  16. Design & Methods • Cluster Randomised Controlled Trial with a Process Evaluation • 8 of the 14 districts from Central and Northern Malawi are randomised to the intervention • Methods (Mixed) • Quantitative (hospital outcome data) • Qualitative(interviews with key stakeholders)

  17. Quantitative data Primary data will be extracted from the maternity log and or the summary reports at the district hospitals All health facilities in a district return this data to the district hospital on a monthly basis Data are to be collected retrospectively at three points in time: For the 12 months leading up to start of project (Baseline) At the end of the first year At the end of the second year

  18. Qualitative data Exploring attitudes and behaviours Have we made a difference to practice? • In depth interviews with: • NPC’s • District Medical Officers • District Nursing Officers • Cascades' (who are trained by NPCs) • Supervisors and tutors • Baseline, 12 months and 24 months

  19. TAKE HOME MESSAGES • KEY TO IMPROVING SURVIVAL OR MOTHERS AND BABIES IN SUB-SAHARAN AFRICA IS TO TRAIN HEALTHCARE STAFF AT COALFACE • NON-PHYSICIAN CLINICIANS ARE KEY TO THIS • NOT ONLY A MATTER OF “TASK SHIFTING” OPERATIVE SKILLS • NEED TO DEVELOP LEADERSHIP AND PROFESSIONAL SKILLS TO PRODUCE CLINICAL SERVICE IMPROVEMENTS • NEED TO TEACH TO CASCADE LEARNING TO OTHER MEMBERS OF TEAM IN THEIR DISTRICTS • EVALUATING EFFECT OF INTERVENTION CHALLENGING BUT NECESSARY TO ATTEMPT

More Related