title: Training non-physician mid-level providers of care (associate clinicians) to perform caesarean sections in low-income countries.
abstract: Comprehensive emergency obstetric care including major surgery such as caesarean section is a major health system problem in rural areas of poor countries, where there are no doctors. Innovative trainings of mid-level workforce have now demonstrated viable, scientifically valid solutions. Delegation of major surgery to duly trained 'non-physician clinicians' - 'task shifting' - should be seriously considered to address the human resources crisis in poor countries to cope with current challenges to enhance maternal and neonatal survival. Nationwide, non-physician clinicians in Mozambique perform approximately 90% of caesarean sections at the district hospital level. A comparison between the outcomes of caesarean sections provided by this category and medical doctors, respectively, demonstrates no clinically significant differences. These mid-level providers have a remarkably high retention rate in rural areas (close to 90%). They are cost-effective, as their training and deployment is three times more cost-effective than that of medical doctors.
authors.affiliation: Karolinska Institutet, Stockholm, Sweden. Electronic address: staffan.bergstrom@ki.se.
authors.forename: Staffan
authors.initials: S
authors.lastname: Bergström
mesh_terms: D017954:Africa South of the Sahara; D002585:Cesarean Section / Q000193:education* / Q000592:standards; D003695:Delivery of Health Care / Q000191:economics; D003906:Developing Countries; D004630:Emergencies; D005260:Female; D006282:Health Personnel / Q000193:education* / Q000523:psychology; D006801:Humans; D009042:Motivation; D007744:Obstetric Labor Complications / Q000601:surgery*; D011247:Pregnancy; D024382:Professional Role; D019035:Rural Health Services / Q000191:economics / Q000600:supply & distribution; D000078329:Workforce
keywords: Mozambique; Tanzania; caesarean section; clinical audit; maternal mortality; task shifting