title: Can training non-physician clinicians/associate clinicians (NPCs/ACs) in emergency obstetric, neonatal care and clinical leadership make a difference to practice and help towards reductions in maternal and neonatal mortality in rural Tanzania? The ETATMBA project.
abstract: OBJECTIVE
  During late 2010, 36 trainees including 19 assistant medical officers (AMOs) 1 senior clinical officer (CO) and 16 nurse midwives/nurses were recruited from districts across rural Tanzania and invited to join the Enhancing Human Resources and Use of Appropriate Technologies for Maternal and Perinatal Survival in the sub-Saharan Africa (ETATMBA) training programme. The ETATMBA project was training associate clinicians (ACs) as advanced clinical leaders in emergency obstetric care. The trainees returned to health facilities across the country with the hope of being able to apply their new skills and knowledge. The main aim of this study was to explore the impact of the ETATMBA training on health outcomes including maternal and neonatal morbidity and mortality in their facilities. Secondly, to explore the challenges faced in working in these health facilities.
  
  
  METHODS
  The study is a pre-examination/postexamination of maternal and neonatal health indicators and a survey of health facilities in rural Tanzania. The facilities surveyed were those in which ETATMBA trainees were placed post-training. The maternal and neonatal indicators were collected for 2011 and 2013 and the survey of the facilities was in early 2014.
  
  
  RESULTS
  16 of 17 facilities were surveyed. Maternal deaths show a non-significant downward trend over the 2 years (282-232 cases/100,000 live births). There were no significant differences in maternal, neonatal and birth complication variables across the time-points. The survey of facilities revealed shortages in key areas and some are a serious concern.
  
  
  CONCLUSIONS
  This study represents a snapshot of rural health facilities providing maternal and neonatal care in Tanzania. Enhancing knowledge, practical skills, and clinical leadership of ACs may have a positive impact on health outcomes. However, any impact may be confounded by the significant challenges in delivering a service in terms of resources. Thus, training may be beneficial, but it requires an infrastructure that supports it.
authors.affiliation: Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK.
authors.forename: David R
authors.initials: DR
authors.lastname: Ellard
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Aloisia
authors.initials: A
authors.lastname: Shemdoe
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Festo
authors.initials: F
authors.lastname: Mazuguni
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Mbaruku
authors.affiliation: Educational Development & Research Team, Warwick Medical School, The University of Warwick, Coventry, UK.
authors.forename: David
authors.initials: D
authors.lastname: Davies
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Paul
authors.initials: P
authors.lastname: Kihaile
authors.affiliation: Tanzanian Training Centre for International Health, Ifakara, Tanzania.
authors.forename: Senga
authors.initials: S
authors.lastname: Pemba
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Bergström
authors.affiliation: Tanzanian Training Centre for International Health, Ifakara, Tanzania.
authors.forename: Angelo
authors.initials: A
authors.lastname: Nyamtema
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Hamed-Mahfoudh
authors.initials: HM
authors.lastname: Mohamed
authors.affiliation: Division of Metabolic and Vascular Health, Warwick Medical School, The University of Warwick, Coventry, UK.
authors.forename: Joseph Paul
authors.initials: JP
authors.lastname: O'Hare
mesh_terms: D000488:Allied Health Personnel / Q000193:education*; D003152:Community Health Nursing / Q000193:education; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007857:Leadership; D063130:Maternal Death; D008880:Midwifery / Q000193:education; D018743:Perinatal Care / Q000458:organization & administration*; D010823:Physician Assistants / Q000193:education; D015397:Program Evaluation; D012423:Rural Health; D013636:Tanzania
keywords: Associate clinicians; Non-physician clinicians; Tanzania; human resources; maternal mortality; medical education and training