The contribution of non-physician clinicians to the provision of surgery in rural Zambia—a randomised controlled trial

Autor: Chiara Pittalis, Leon Bijlmakers, Mweene Cheelo, John Kachimba, Jakub Gajewski, Ruairi Brugha
Jazyk: angličtina
Předmět:
Rural Population
Malawi
Public Administration
medicine.medical_treatment
Allied Health Personnel
Health administration
law.invention
0302 clinical medicine
Randomized controlled trial
law
Medicine
Health Workforce
030212 general & internal medicine
lcsh:R5-920
030503 health policy & services
lcsh:Public aspects of medicine
1. No poverty
Health services research
Hernia repair
Task-shifting
3. Good health
Surgical Procedures
Operative
Workforce
Clinical Competence
Delegation
Professional
0305 other medical science
lcsh:Medicine (General)
medicine.medical_specialty
MEDLINE
Zambia
Developing country
03 medical and health sciences
Non-physician clinicians
All institutes and research themes of the Radboud University Medical Center
Medical licentiates
Intervention (counseling)
Humans
Clinical officers
Developing Countries
business.industry
Research
Public Health
Environmental and Occupational Health
lcsh:RA1-1270
Surgery
Global surgery
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
Patient outcomes
business
Zdroj: Human Resources for Health, Vol 17, Iss 1, Pp 1-8 (2019)
Human Resources for Health, 17, 1
Human Resources for Health, 17
Human Resources for Health
ISSN: 1478-4491
DOI: 10.1186/s12960-019-0398-9
Popis: Contains fulltext : 220867.pdf (Publisher’s version ) (Open Access) BACKGROUND: The global shortage of surgeons disproportionately impacts low- and middle-income countries. To mitigate this, Zambia introduced a 'task-shifting' solution and started to train non-physician clinicians (NPCs) called medical licentiates (ML) to perform surgery. The aim of this randomised controlled trial was to assess their contribution to the delivery of surgical care in rural hospitals in Zambia. METHODS: Sixteen hospitals were randomly assigned to intervention and control arms of the study. Nine MLs were deployed to eight intervention sites. Crude numbers of selected major surgical procedures between intervention and control sites were compared before and after the intervention. Volume and outcomes of surgery were compared within intervention hospitals, between NPCs and surgically active medical doctors (MDs). RESULTS: There was a significant increase in the numbers of caesarean sections (CS) in the intervention hospitals (+ 15.2%) and a drop by almost half in the control group (- 47%) (P = 0.015), between the two time periods. There were marginal shifts in the numbers of index procedures: a small drop in the intervention group (- 4.9%) and slight increase in the control arm (+ 4.8%) (P = 0.505). In all pairs, MLs had higher mean number of CS and other major surgical cases done in the intervention period compared with MDs. There was no significant difference in postoperative wound infection rates for CS (P = 0.884) and other major surgical cases (P = 0.33) at intervention hospitals between MLs and MDs. CONCLUSION: This study provided evidence that the ML training programme in Zambia is an effective and safe way to bridge the gap in rural hospitals between the demand and the limited availability of surgically trained workforce in the country. Such evidence is greatly needed as more developing countries are developing national surgical plans. TRIAL REGISTRATION: ISRCTN66099597 Registered: 07/01/2014.
Databáze: OpenAIRE
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