title: Surgical task-shifting in a low-resource setting: outcomes after major surgery performed by nonphysician clinicians in Tanzania.
abstract: BACKGROUND
  Little is known about the breadth and quality of nonobstetric surgical care delivered by nonphysician clinicians (NPCs) in low-resource settings. We aimed to document the scope of NPC surgical practice and characterize outcomes after major surgery performed by nonphysicians in Tanzania.
  
  
  METHODS
  A retrospective records review of major surgical procedures (MSPs) performed in 2012 was conducted at seven hospitals in Pwani Region, Tanzania. Patient and procedure characteristics and level of surgical care provider were documented for each procedure. Rates of postoperative morbidity and mortality after nonobstetric MSPs performed by NPCs and physicians were compared using multivariate logistic regression.
  
  
  RESULTS
  There were 6.5 surgical care providers per 100,000 population performing a mean rate of 461 procedures per 100,000 population during the study period. Of these cases, 1,698 (34.7 %) were nonobstetric MSPs. NPCs performed 55.8 % of nonobstetric MSPs followed by surgical specialists (28.7 %) and medical officers (15.5 %). The most common nonobstetric MSPs performed by NPCs were elective groin hernia repair, prostatectomy, exploratory laparotomy, and hydrocelectomy. Postoperative mortality was 1.7 % and 1.5 % in cases done by NPCs and physicians respectively. There was no significant difference in outcomes after procedures performed by NPCs compared with physicians.
  
  
  CONCLUSIONS
  Surgical output is low and the workforce is limited in Tanzania. NPCs performed the majority of major surgical procedures during the study period. Outcomes after nonobstetric major surgical procedures done by NPCs and physicians were similar. Task-shifting of surgical care to nonphysicians may be a safe and sustainable way to address the global surgical workforce crisis.
authors.affiliation: Department of Surgery, University of California, San Francisco (UCSF), 513 Parnassus Ave S-321, San Francisco, CA, 94143-0470, USA, jessica.beard@ucsfmedctr.org.
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Beard
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Oresanya
authors.forename: Larry
authors.initials: L
authors.lastname: Akoko
authors.forename: Ally
authors.initials: A
authors.lastname: Mwanga
authors.forename: Charles A
authors.initials: CA
authors.lastname: Mkony
authors.forename: Rochelle A
authors.initials: RA
authors.lastname: Dicker
mesh_terms: D000068:Accreditation; D002983:Clinical Competence; D016208:Databases, Factual; D003906:Developing Countries; D005260:Female; D006295:Health Resources / Q000191:economics*; D006769:Hospitals, General; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009720:Nurse Clinicians / Q000458:organization & administration*; D011203:Poverty; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D013636:Tanzania; D016896:Treatment Outcome