title: A qualitative process evaluation of training for non-physician clinicians/associate clinicians (NPCs/ACs) in emergency maternal, neonatal care and clinical leadership, impact on clinical services improvements in rural Tanzania: the ETATMBA project.
abstract: OBJECTIVE
  The Enhancing Human Resources and Use of Appropriate Training for Maternal and Perinatal Survival in sub-Saharan Africa (ETATMBA) project is training non-physician clinicians as advanced clinical leaders in emergency maternal and newborn care in Tanzania and Malawi. The main aims of this process evaluation were to explore the implementation of the programme of training in Tanzania, how it was received, how or if the training has been implemented into practice and the challenges faced along the way.
  
  
  METHODS
  Qualitative interviews with trainees, trainers, district officers and others exploring the application of the training into practice.
  
  
  METHODS
  During late 2010 and 2011, 36 trainees including 19 assistant medical officers one senior clinical officer and 16 nurse midwives/nurses (anaesthesia) were recruited from districts across rural Tanzania and invited to join the ETATMBA training programme.
  
  
  RESULTS
  Trainees (n=36) completed the training returning to 17 facilities, two left and one died shortly after training. Of the remaining trainees, 27 were interviewed at their health facility. Training was well received and knowledge and skills were increased. There were a number of challenges faced by trainees, not least that their new skills could not be practised because the facilities they returned to were not upgraded. Nonetheless, there is evidence that the training is having an effect locally on health outcomes, like maternal and neonatal mortality, and the trainees are sharing their new knowledge and skills with others.
  
  
  CONCLUSIONS
  The outcome of this evaluation is encouraging but highlights that there are many ongoing challenges relating to infrastructure (including appropriate facilities, electricity and water) and the availability of basic supplies and drugs. This cadre of workers is a dedicated and valuable resource that can make a difference, which with better support could make a greater contribution to healthcare in the country.
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 & 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; D007407:Interviews as Topic; 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