Frank Taulo | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Task shifting is one way to optimize health worker roles to reduce maternal and neonatal mortality, particularly in hard-to-reach geographical areas and in communities with low social and economic status. Facing a critical shortage of human resources in the health sector, Malawi began training a mid-level cadre of clinical officers (COs) in 1976 to expand access to surgical services. This program has been scaled up such that all COs are licensed to perform the nine comprehensive emergency obstetric care (CEmOC) signal functions of which C-sections are one. Reports find COs perform C-sections as effectively as physicians and current estimates show 90% of C-Sections in Malawi are performed by non-physician clinicians. As countries increasingly address HRH shortages through task shifting approaches, Malawi’s experience represents an important opportunity to explore the attitudes and perceptions of providers to whom tasks are ‘shifted’.

Methods: Within the context of a case study to document facilitators and barriers to Malawi’s scale-up of C-sections by non-physicians, this study will examine the perceptions and experiences of physicians, nurses and clinical officers and other cadres affected by task shifting. Self-administered questionnaires and focus group discussions will be used to explore provider motivation and attitudes.

Results: The results of this mixed methods study will be presented, focusing on CO job satisfaction, motivation, fairness of remuneration, and perceptions of ability to provide quality CEmOC.

Conclusions: This examination of health worker experiences will contribute to the understanding of Malawi’s success in scaling up task shifting, including how provider experiences may have facilitated the program’s advancement. As Malawi aims to improve access to essential services and to increase its overall C-section rate from 5% to the WHO recommended of 10-15%, the provider perspective may also lend important insights to MNCH policy makers and planners, with potential applicability for other countries.