IFGH 2012: Who is doing what? Performance of the Emergency Obstetric Signal Functions by Non- Physician Clinicians and Nurse-Midwives in Malawi, Mozambique, and Tanzania

January 30, 2012

Authors:The following 5 HSSE Team

Averting Maternal Death and Disability Program (AMDD), Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, USA; Ifakara Health Institute, Mikocheni, Dar Es Salaam, Tanzania; University of Malawi, College of Medicine, Centre for Reproductive Health, Malawi; Centre for Global Health, University of Dublin, Trinity College; Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Mozambique

Option 1– Scientific / Empirical Research Findings Presented as – Oral Presentation


The Health System Strengthening for Equity: The Power and Potential of Mid- Level Providers (HSSE) project sought to document the current use of nurses, nurse-midwives and NPCs in delivering EmOC in Malawi, Mozambique, and Tanzania.
One of the main aims of the project was to explore actual performance of EmOC and other related maternal and newborn health services by health workers who provided at least one of the EmOC signal functions in the previous three months preceding data collection in hospitals and health centres throughout Malawi, Mozambique, and Tanzania.


A total of 2,065 health care providers from 286 facilities were surveyes in the three countries. Nurses, nurse-midwives, and NPCs comprised 75% of respondents (N=1,552).


EmOC signal functions are being performed by a wide range of skilled health care providers in the three study countries.

Over 75% of the nurses and nurse-midwives in the three study countries are providing four of the basic EmOC signal functions: administering parenteral antibiotics, uterotonics and anticonvulsants, as well as neonatal resuscitation.

Performance of all the comprehensive EmOC signal functions by NPCs was mixed.


Discussion/conclusions/ implications:

This study found that a range of skilled MLPs are providing life-saving EmOC signal functions in Malawi, Mozambique, and Tanzania, with nurses and nurse-midwives providing most of the basic EmOC signal functions and NPCs (and high level nurses in Mozambique) providing comprehensive EmOC. These MLPs and NPCs are providing care at different levels of the health care system, which often influences what EmOC services can and are provided to women in need. Given the paucity of doctors in these countries, our data reinforce the crucial role and use of MLPs as an innovative solution to addressing the human resource crisis in these countries.




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