title: Task shifting and sharing in Tigray, Ethiopia, to achieve comprehensive emergency obstetric care.
abstract: OBJECTIVE
  To assess the contribution of nonphysician clinicians (NPCs) to comprehensive emergency obstetric care (CEmOC) in Tigray, Ethiopia.
  
  
  METHODS
  We conducted a retrospective review of the obstetric records of all women treated from January 1, 2006, to December 31, 2008, at the 11 hospitals and 2 health centers with CEmOC status in Tigray. Data were collected using 2 questionnaires, one concerning the facility and the other concerning the patient.
  
  
  RESULTS
  During the studied period 25,629 deliveries and 11,059 obstetric procedures (3369 of which were major surgical interventions) were performed at these 13 institutions. Overall, NPCs performed 63.3% of these procedures, which included 1574 (55.5%) of a total of 2835 cesarean deliveries. Whereas the cesarean deliveries performed by physicians were more often elective, those performed by NPCs were more often indicated by an emergency. Maternal deaths, fetal deaths, and length of hospital stay did not statistically differ by type of attending staff.
  
  
  CONCLUSIONS
  Not only do NPCs perform a significant proportion of emergency obstetric procedures in Tigray, but the postoperative outcomes achieved under their care are similar to those attained by physicians. Strengthening NPC training programs in emergency obstetric surgery should further reduce maternal and fetal mortality and morbidity in Ethiopia.
authors.affiliation: Office of the Head of the Bureau, Tigray Health Bureau, Tigray, Ethiopia.
authors.forename: Amanuel
authors.initials: A
authors.lastname: Gessessew
authors.forename: Gebre Ab
authors.initials: GA
authors.lastname: Barnabas
authors.forename: Ndola
authors.initials: N
authors.lastname: Prata
authors.forename: Karen
authors.initials: K
authors.lastname: Weidert
mesh_terms: D000328:Adult; D000488:Allied Health Personnel / Q000193:education / Q000458:organization & administration*; D002585:Cesarean Section / Q000193:education / Q000379:methods; D036861:Delivery, Obstetric / Q000193:education / Q000379:methods*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005002:Ethiopia; D005260:Female; D006801:Humans; D007902:Length of Stay; D013513:Obstetric Surgical Procedures / Q000193:education / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D000078329:Workforce; D055815:Young Adult