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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Expected to deliver: Alignment of regulation, training, and actual performance of emergency obstetric care providers in Malawi and Tanzania
International Journal of Gynecology and Obstetrics, Volume 115, No. 3, Year 2011
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Description
Objective: Policy, regulation, training, and support for cadres adopting tasks and roles outside their historical domain have lagged behind the practical shift in service-delivery on the ground. The Health Systems Strengthening for Equity (HSSE) project sought to assess the alignment between national policy and regulation, preservice training, district level expectations, and clinical practice of cadres providing some or all components of emergency obstetric care (EmOC) in Malawi and Tanzania. Methods: A mixed methods approach was used, including key informant interviews, a survey of District Health Management Teams, and a survey of health providers employed at a representative sample of health facilities. Results: A lack of alignment between national policy and regulation, training, and clinical practice was observed in both countries, particularly for cadres with less preservice training; a closer alignment was found between district level expectations and reported clinical practice. There is ineffective use of cadres that are trained and authorized to provide EmOC, but who are not delivering care, especially assisted vaginal delivery. Conclusion: Better alignment between policy and practice, and support and training, and more efficient utilization of clinical staff are needed to achieve the quality health care for which the Malawian and Tanzanian health ministries and governments are accountable. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Authors & Co-Authors
Lobis, Samantha
United States, New York
Mailman School of Public Health
Mbaruku, Godfrey M.
Tanzania, Ifakara
Ifakara Health Institute
Kamwendo, Francis
Malawi, Zomba
University of Malawi
McAuliffe, E.
Ireland, Dublin
Trinity College Dublin
Austin, Judy
United States, New York
Mailman School of Public Health
de Pinho, Helen
United States, New York
Mailman School of Public Health
Statistics
Citations: 33
Authors: 6
Affiliations: 4
Identifiers
Doi:
10.1016/j.ijgo.2011.09.008
ISSN:
00207292
e-ISSN:
18793479
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Cross Sectional Study
Study Approach
Quantitative
Mixed-methods
Study Locations
Malawi
Tanzania