Task shifting of emergency caesarean section in south Ethiopia: are we repeating the brain drain

• Published in: The Pan African medical journal 2020-07, Vol.36 (145), p.145-145
• Main Authors: Asefa, Anteneh, Morgan, Alison, Hailemariam, Tadesse, Shiferaw, Mekonnen, Mekonnen, Emebet, Birhan, Yifru
• Format: Article
• Language: English
• Subjects: Adult; attrition; caesarean section; Cesarean Section - adverse effects; Cesarean Section - education; Cesarean Section - mortality; Cesarean Section - statistics & numerical data; Clinical Audit; Clinical Competence - standards; Clinical Competence - statistics & numerical data; Cross-Sectional Studies; delivery; Delivery, Obstetric - education; Delivery, Obstetric - methods; Delivery, Obstetric - standards; Delivery, Obstetric - statistics & numerical data; Emergency Medical Services - methods; Emergency Medical Services - statistics & numerical data; ethiopia; Ethiopia - epidemiology; Female; Health Services Accessibility - organization & administration; Humans; Infant, Newborn; Maternal Death - prevention & control; Parturition; Perinatal Mortality; Personnel Staffing and Scheduling - organization & administration; Personnel Staffing and Scheduling - standards; Pregnancy; primary hospital; Quality Improvement - organization & administration; Quality Improvement - standards; Shift Work Schedule - standards; task shifting; Workload - standards
• ISSN: 1937-8688; 1937-8688
• DOI: 10.11604/pamj.2020.36.145.19330

preventable mortality from complications which arise during pregnancy and childbirth continue to claim more than a quarter of million women´s lives every year, almost all in low- and middle-income countries. However, lifesaving emergency obstetric services, including caesarean section (CS), significantly contribute to prevention of maternal and newborn mortality and morbidity. Between 2009 and 2013, a task shifting intervention to train caesarean section (CS) teams involving 41 CS surgeons, 35 anesthetic nurses and 36 scrub nurses was implemented in 13 hospitals in southern Ethiopia. We report on the attrition rate of those upskilled to provide CS with a focus on the medium-term outcomes and the challenges encountered. a cross-sectional study involving surveys of focal persons and a facility staff audit supplemented with a review of secondary data was conducted in thirteen hospitals. Mean differences were computed to appreciate the difference between numbers of CSs conducted for the six months before and after task shifting commenced. from the trained 112 professionals, only 52 (46.4%) were available for carrying out CS in the hospitals. CS surgeons (65.9%) and nurse anesthetists (71.4%) are more likely to have left as compared to scrub nurses (22.2%). Despite the loss of trained staff, there was an increase in the number of CSs performed after the task shifting (mean difference=43.8; 95% CI: 18.3-69.4; p=0.003). our study, one of the first to assess the medium-term effects of task shifting highlights the risk of ongoing attrition of well-trained staff and the need to reassess strategies for staff retention.