Presentation at the Global Maternal Newborn Health Conference, October 21, 2015
Background: Countries with human resource shortages are increasingly looking for innovative approaches to get high quality, life-saving Comprehensive Emergency Obstetric Care (CEmOC) to women in rural areas. Task shifting, such as training non-physicians to perform advanced surgical procedures, is one such strategy. In Zambia, clinical officers based in rural areas were trained in emergency surgery, including cesarean sections, to move life-saving skills ‘closer to home’. These clinicians, medical licentiate practitioners (MLPs), have been largely misunderstood despite their fundamental role in many rural hospitals throughout the country. We examined the implementation of the MLP program and evaluated the impact of task shifting on the motivation and performance of this professional cadre.
Methodology: A mixed methods approach was employed. Key informant interviews of 61 providers were conducted in three provinces and Lusaka, and a self-administered provider survey was sent to all practicing MLPs to measure burnout, job satisfaction, and motivation and to assess the clinical work being conducted.
Results: MLPs reported high levels of job satisfaction and motivation, were well-respected by district and provincial level administrators and clinical colleagues, had low levels of attrition, reduced the number of referrals, and were performing over 50% of C-sections when on duty. However, several health systems challenges led to high levels of burnout and threats to sustainability: lack of legal protection, limited career advancement opportunities, unjust remuneration and a general lack of understanding of their place in the health system at the national level.
Conclusion: For countries looking to establish a task-shifting program for CEmOC, the importance of training experienced clinicians, clearly articulating their role in the health system, adequately compensating them and providing clear career progression opportunities are fundamental to the creation of a sustainable and integrated cadre.