Improving maternal and perinatal health care in Africa
The ETATMBA (Enhancing Human Resources and Use of Appropriate Training for Maternal and Perinatal Survival In Sub-Saharan Africa) project was established to improve healthcare, delivery and training to address issues threatening maternal and perinatal survival. Developing obstetric and neonatal clinical skills with “on the job training” ensured that task shifting of the emergency care of mothers and babies was more effective and safer, allowing access to help for mothers in remote rural areas of Malawi and Tanzania. The training focused on service improvement through the use of clinical guidelines and pathways, structured education and the innovative use of leadership training for non-physician clinicians (NPCs), thus ensuring that the health service improvements would be sustained and developed after the project. Support for NPCs in the workplace focused on advanced leadership training which they could in turn pass on to the rest of the healthcare team in their districts. Mentorship by both local and international physicians was key to this process. A total of 100 NPCs were trained in obstetric and neonatal care, leadership and clinical service improvement: 46 completed a full, accredited BSc in obstetrics and leadership in Malawi and 54 completed a 6-month training course in Tanzania. The study included research with both qualitative and quantitative evaluation, which has demonstrated the positive benefits of advanced training for NPCs for the future of healthcare in SSA. ETATMBA's leadership element distinguishes it from other initiatives: leadership training has helped to build capacity and improve services and proved central to the project's delivery in both countries. The content and teaching materials of the BSc modules are freely available to trainers in low-income countries and can be accessed online. National guidelines were reviewed in close collaboration with authorities in the Ministry of Health in Malawi and the Ministry of Health and Social Welfare in Tanzania. The focus was not so much on the creation of a new set of guidelines, but on their internalisation and implementation and ownership by the health care team as a core aspect of clinical practice. The importance of best practice through implementation was an essential aspect of NPCs’ training, tailored according to each country’s needs and capacities. ETATMBA has contributed to improving maternal and neonatal health care in SSA through training, enhancing clinical guidelines and engaging stakeholders and regulatory authorities. The project’s results, including those of its qualitative and quantitative research, can be used to develop NPC practice and sustain services for delivering quality health care to mothers and babies in Africa.
Keywords
Maternal, perinatal, health care, Africa, non-physician clinicians, assistant medical officers
