Lobis S., Mbaruku G., Kamwendo F., McAuliffe E., Austin J., De Pinho H.
Expected to deliver: Alignment of regulation, training, and actual performance of emergency obstetric care providers in Malawi and Tanzania
Mailman School of Public Health, Columbia University, New York, NY, United States; Ifakara Health Institute, Dar es Salaam, Tanzania; College of Medicine, Blantyre, Malawi; Centre for Global Health, Trinity College, Dublin, Ireland
Lobis, S., Mailman School of Public Health, Columbia University, New York, NY, United States; Mbaruku, G., Ifakara Health Institute, Dar es Salaam, Tanzania; Kamwendo, F., College of Medicine, Blantyre, Malawi; McAuliffe, E., Centre for Global Health, Trinity College, Dublin, Ireland; Austin, J., Mailman School of Public Health, Columbia University, New York, NY, United States; De Pinho, H., Mailman School of Public Health, Columbia University, New York, NY, United States
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.
article; clinical practice; comparative study; emergency obstetric care; health care personnel; health care policy; health care quality; human; interview; Malawi; midwife; obstetric care; performance; physician; priority journal; registered nurse; Tanzania; training; vaginal delivery; Data Collection; Delivery of Health Care; Delivery, Obstetric; Emergency Medical Services; Female; Health Policy; Humans; Malawi; Maternal Health Services; Pregnancy; Quality of Health Care; Tanzania