PHA-Exch> course information

[Claudio Schuftan]

From: Staffan Bergström <staffan.bergstrom at ki.se>
 This is a course FREE OF COST (all accommodation, meals and
all books and other course material provided free of cost) and presumably
the only one in he world focusing on non-physician clinicians (NPCs) to save
maternal and newborns' lives.


Staffan Bergstrom, MD, PhD
Professor of International Health
Division of International Health (IHCAR)
Karolinska Institutet
Nobels vag 9
SE-171 77 Stockholm
Sweden

Concept Paper

Advanced training course, NO TUITION FEE, in Gotland, Sweden, August 11-26,
2008:
Addressing the crisis in human resources for maternal and neonatal survival
by training of non-physician clinicians for comprehensive emergency
obstetric care: from scientific evidence to action

Application forms for this course are available from
<staffan.bergstrom at ki.se>.

There is no tuition fee and accommodation and all meals and all course
material, books and handouts will be provided free of cost.

The 5th Millennium Development Goal to reduce maternal mortality by 75%
during the period 1990-2015 is the MDG by far the least on track to be
fulfilled. This has been called the "Scandal of our time" and the human
resource issue is the most fundamental cause of failure. Doctors are absent
in rural areas, where the bulk of maternal mortality occurs.

In a recent article in the Lancet an analysis of 47 African countries has
shown that in more than 50% of these countries "non-physician clinicians"
are actually fulfilling the needs in the absence of conventionally trained
medical doctors. Very few countries in Africa, however, have a formally
legalized category able to perform life-saving surgery to save mothers' and
newborns' lives. Tanzania has "assistant medical officers" almost since its
independence and Malawi has "clinical officers" since 1976. Mozambique
embarked upon a similar development in 1984, in which the "técnico de
cirurgia" training was started. Several countries, not only in Africa but
also in Asia are now grappling with the problem of enhancing maternal and
neonatal survival with the foreseeable failure of attaining MDG 5.

Since 2006 we have been able to visualize the problem of scarcity of human
resources for maternal neonatal survival through the courses in Gotland,
Sweden. Our target group of interest is "mid-level providers of care" in
various African, Asian and Latin American countries. We have, presumably,
the only course in the world targeting these health workers, whom we
consider key individuals to improve the availability of comprehensive
emergency obstetric care to women in need.

The challenge to provide life-saving obstetric surgery among the most
deprived segments of populations in poor countries is made almost impossible
by the shortage of doctors. The medical profession is largely drained away
from rural to urban areas and also away from low-income countries to greener
pastures abroad due to adverse living conditions, low salaries and weak
health policies in countries most in need of live-saving skills to the
poorest, particularly women. In many countries the medical profession has
reacted quite negatively to delegation of live-saving surgical skills to
non-physician clinicians. Unwillingly, the medical profession in some
low-income countries has accepted the fact that life-saving major surgery
has to be delegated to non-physician clinicians since there are simply no
physicians available to perform such life-saving interventions. This
reluctance exists in spite of solid and robust scientific evidence to the
contrary: that non-physician clinicians can perform safely and
satisfactorily such major surgery with enhanced survival of mothers and
their newborns in obstetric emergencies.

There is an urgent need of propagating and disseminating recent research
results, which are quite sensational but non-recognized in the medical
world. These observations comprise the following items:
1)      In Malawi a nationwide study of all district/rural hospitals in the
country with surgical facilities (n = 38) has shown that non-physician
clinicians (clinical officers) currently perform more than 90% of all
caesarean sections.
2)      In Mozambique an almost identical picture prevails at district
hospitals (n=23) in that 92% of all caesarean sections are carried out by
specially trained "técnicos de cirurgia", i.e. surgically trained assistant
medical officers. In the whole country, including national university
hospitals, provincial hospitals and general hospitals the corresponding
figure is 54%. In other words: the vast majority of all obstetric
emergencies are already carried out by non-physician clinicians in
Mozambique. This figure is sensational.
3)      In Tanzania the situation is similar with 80-90% of all such
operations carried out by non-physician clinicians. The results of ongoing
research in Mwanza and Kigoma regions are not yet finalized but final
elaboration of data will be ready soon. The uniqueness of the Tanzania
experiences is largely unknown outside the country. The results are
therefore hitherto completely unrecognized.

We are going to arrange the above mentioned course and are interested to get
to know full names and full e-mail addresses of those being interested to
get an application form. We are keen to have as many applicants as possible
and count on having mid-level providers of care, medical doctors nominated
for training of such mid-level providers and also Ministry of Health
officials devoted to and having responsibility for human resource
development in different countries in Africa, Asia and Latin America.

Application forms for this course are available from
<staffan.bergstrom at ki.se>

THE DEADLINE FOR APPLICATION WILL BE SUNDAY MAY 18, 2008.
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