IMPROVE THE SURVIVAL OF MOTHERS AND BABIES IN AFRICA THE ETATMBA PROJECT DR PAUL OHARE PROJECT LEAD ETATMBA Enhancing Training and Appropriate Technologies for Mothers and Babies in Africa ID: 751986
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TRAINING NON-PHYSICIAN CLINICIANS TO
IMPROVE THE SURVIVAL OF MOTHERS AND BABIES IN AFRICA – THE ETATMBA PROJECT
DR PAUL O’HARE
PROJECT LEADSlide2
ETATMBA:
(Enhancing Training and Appropriate Technologies for Mothers and Babies in Africa)
ETATMBA is a European Commission FP7 funded
project being delivered in
Tanzania and Malawi
Partners:The University of Warwick (UK)Karolinska Institute (Sweden)Ifakara Health Institute, TanzaniaThe University of MalawiThe Ministry of Health (Malawi)GE Healthcare (UK)Slide3Slide4Slide5
600,000 women and 7 million babies die annually in childbirth.
When obstetric and neonatal emergencies arise most Sub-Saharan African women face childbirth without access to skilled health workers.
Education, training and retention of health professionals is the key to improving healthcare for mothers and babies in Africa.In the modern world this tragedy is unacceptable and largely preventable.Slide6
ETATMBA (Enhancing Training and Appropriate Technologies for Mothers and Babies in Africa)
Very
few Medical Doctors
in
Malawi and Tanzania
260* approximately 1 Medical Doctor per 50,000 peopleSimilar to other African Countries much of this work is done by:Non-Physician Clinicians (NPCs) *Data from 2009Slide7
Non-Physician Clinicians
(NPCs) are an effective and retainable health solution for doctor-less rural and many urban areas of Africa.
Task-shifting to NPCs needs to be: extendedenhancedendorsed and supported by the healthcare community.Karolinska (S.B.), global health lead in advocating and evaluating NPCs. Needs to be developed, scaled up and be sustainable in an African setting. Warwick expertise in scaling up health professional educational delivery.Slide8
Peirera & Bergström
2071 Caesarean Sections
- Non-Clinician Physicians - Doctors in District hospitals (Medical Officers)No clinically significant difference in outcomeMozambique 2002 – NPCs (TCs) performed 57% of 12000 caesarean section ruptured uterus ectopic pregnancyRural areas 92% of 3246Slide9
Retention of DRs in Africa
‘There are more Malawi doctors in Manchester than Malawi’
Newly graduated Malawi doctors are sent to district/rural posts but none remain in these posts after 7 years.88% of NPCs (TC) are retained in their original postButProfessional StatusContinuing Professional DevelopmentMaintenance and progression of standards
Sustainability of resource
Training in leadership in HealthSlide10
Non-Physician
Clinicians (NPC’s)
“The crisis in human healthcare resources disproportionately affects the poorest women
in low income countries
.”
“Are non-physician clinicians a substandard solution to the crisis in human resources for maternal health?”“Evidence suggests that the answer is no.”Bergström , BMJ 2011;342:d2499 doi: 10.1136/bmj.d2499Slide11
“The Warm Heart of Africa”Slide12Slide13
Facts about Malawi
(General)
Malawi is 45.7472
miles (118.483
2
km) in sizeEngland is 50.3462 miles (130.3952 km)Malawi (formally Nyasaland)Was a British Colony until 1964Lake Malawi (Lake Nyasa) 3rd largest in Africa 8th
in world Main
language is English (and they drive on the left!)Population is currently about 15 Million
Predicted to rise to 45 Million by 205080% are Christian and about 13% Muslim
Education: Entitled to 5 years primary education (not compulsory)
Uptake is low but improvingA resource poor country (some tobacco, sugar, tea etc…)
Agriculture, Subsistence
farming (Maize being main crop) Slide14Slide15
Main Health Issues
Life expectancy at birth:
Total population: 51.7 yearsMale: 50.93 years
Female: 52.48 years
HIV/AIDS
WHO suggest 13% of population but data from 2007 (Just under 1 Million people living with HIV/AIDS)MalariaMaternal and Neonatal Mortality(2011 estimates WHO)Slide16
Healthcare Spend Per Capita (USD)
USA, $7,410*
UK, $3,399*Malawi, $50**Source: WHO (Global Health Observatory, 2009)Slide17
ETATMBA
The project is to train
50 Non-Physician Clinicians (NPCs) as advanced leaders providing them with skills and knowledge in advanced neonatal and obstetric care (over a 24 month period).
Training
it is hoped that will be cascaded to their colleagues (other NPCs, midwives, nurses).
The aim of the project is to try and address the high levels of maternal and neonatal mortality.Slide18Slide19
Clinical Service Improvement will be developed, implemented and evaluated through:
clinical guidelines and pathways,
structured education, clinical leadership training and workforce development of NPCs and faculty.Slide20
Evaluating the impact of ETATMBA
The
aim of this study is to:Evaluate
the impact on healthcare outcomes of
the ETATMBA training in Malawi.
OUTCOMES (Primary):Perinatal mortality (defined as fresh stillbirths and neonatal deaths before discharge from the health care facility)OUTCOMES (Secondary):Maternal death rates;Recorded data (e.g. still births, Post-Partum Haemorrhage, C Section, Eclampsia, Sepsis,
Neonatal resuscitation);Availability of resources (e.g. are drugs/blood available);
Use of available resources (e.g. are drugs being used).Slide21
Design & Methods
Cluster Randomised Controlled Trial with a Process Evaluation
8 of the 14 districts from Central and Northern Malawi are randomised to the interventionMethods (Mixed)Quantitative (hospital outcome data)
Qualitative(interviews with key stakeholders)Slide22
Quantitative data
Primary data will be extracted from the maternity
log and or the summary reports at
the district
hospitals
All health facilities in a district return this data to the district hospital on a monthly basisData are to be collected retrospectively at three points in time:For the 12 months leading up to start of project (Baseline)At the end of the first yearAt the end of the second yearSlide23
Qualitative data
In depth interviews with:
NPC’s
District Medical Officers
District Nursing Officers
Cascades' (who are trained by NPCs)Supervisors and tutorsBaseline, 12 months and 24 monthsExploring attitudes and behavioursHave we made a difference to practice? Slide24Slide25
TAKE HOME MESSAGES
KEY TO IMPROVING SURVIVAL OR MOTHERS AND BABIES IN SUB-SAHARAN AFRICA IS TO TRAIN HEALTHCARE STAFF AT COALFACE
NON-PHYSICIAN CLINICIANS ARE KEY TO THIS
NOT ONLY A MATTER OF “TASK SHIFTING” OPERATIVE SKILLS
NEED TO DEVELOP LEADERSHIP AND PROFESSIONAL SKILLS TO PRODUCE CLINICAL SERVICE IMPROVEMENTS
NEED TO TEACH TO CASCADE LEARNING TO OTHER MEMBERS OF TEAM IN THEIR DISTRICTSEVALUATING EFFECT OF INTERVENTION CHALLENGING BUT NECESSARY TO ATTEMPT