PHA-Exch> Trg in Sweden:Enhancing access to human resources for maternal and neonatal survival

[Claudio Schuftan]

*Advanced training course in Sweden arranged jointly by: ** **Columbia
University, Averting Maternal Death and Disability (AMDD) program, New York,
USA Karolinska Institutet, Division of International Health (IHCAR),
Stockholm, Sweden*

 *"Enhancing access to human resources for maternal and neonatal survival
through task-shifting by training of non-physician clinicians for 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 course will run August 17-30, 2009 in Gotland, Sweden.*



*Background and rationale*

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 an 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 much of the needs of advanced clinical skills in the
absence of conventionally trained physicians. The concept of *
"task-shifting"* (originally much used in the context of HIV care) has come
to mean an important advancement also in comprehensive emergency obstetric
care. 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 a
three year training
to become "técnico de cirurgia" was started. *Zambia* initiated in 2002 a
three year training of clinical officers to become "medical licentiates" and
in early 2009 *Ethiopia* is embarking upon a three year MSc training
programme of "integrated emergency obstetrics and surgery" aimed at
upgrading skills of "health officers".  Several countries, *not only in
Africa but also in Asia and Latin America* are now grappling with the
problem of enhancing maternal and neonatal survival with the foreseeable
failure of attaining MDG 4 and 5.



Since 2006 we have been able to address the problem of scarcity of human
resources with special focus on "task-shifting" for maternal and neonatal
survival through the courses in Gotland, Sweden. Our target group of
interest is "mid-level providers of care", *including midwives* 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.



There is an urgent need of propagating and disseminating recent research
results, which are quite sensational but not yet 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 two regions, Mwanza and Kigoma, all hospitals have been
analysed and  the situation is similar with around 85% of all such
operations carried out by non-physician clinicians.



We are interested to get full names and e-mail addresses of those being
interested to get an application form. Like previous years we count on
having application forms from various non-physician clinicians incl.
midwives and medical doctors involved in training of such cadres in Africa,
Asia and Latin America.



Target groups:



1)    Non-physician clinicians (NPCs) - i.e. clinical officers, assistant
medical officers, técnicos de cirurgia and midwives - with experience of
comprehensive emergency obstetric care and in surgery from Africa, Asia and
Latin America

2)    Medical doctors with experience of training NPCs in these fields in
the continents mentioned.



*Course objectives*

1)    Share task-shifting experiences between participants in emergency
obstetric care.

2)    Provide tools for improving quality of care through use of audit and
process indicators.

3)    Develop occupational profiles of NPCs cadres in a team approach.

4)    Upgrade clinical knowledge and skills in emergency obstetric care.

* *

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


THE *DEADLINE* FOR APPLICATION WILL BE *FRIDAY 1ST OF MAY 2009*.

 APPLICATION FORM



* *

*When application is submitted, please send an e-mail with this form
attached or fax the form. *



*Selected participants will be informed at the latest on Friday 15th May,
2009.*



I hereby apply to participate in the above mentioned course:



*Surname/Family name** (as in your passport):*

* *

*First name (as in your passport): *

* *

*Nationality:*

* *

*Male/female:  *

* *

*Birth date (year/month/day):   _ _ _ _     _ _     _ _*

* *

*Category: * assistant medical officer      ** clinical officer
**health officer
  medical licentiate    medical doctor and tutor      midwife      other
(specify):

* *

*Profession/educational level:  *

* *

*Affiliated to (university/college or other institution if applicable):*

* *

*Current hospital (or other) employment:*

* *

*Complete air mail address**: *

* *

*E-mail address**:  *

* *

*Best telephone no. to contact** (country and area code): *

* *

*Fax** (country and area code): *
  PERSONAL BACKGROUND (use more space if needed)

* *

*1)  I am interested in this course for the following reasons:*













*2)  In my professional work I have been involved in emergency obstetric
care in the following way (brief description):*











*3)  In my professional work I have been involved in surgical activities in
the following way (brief description):*











*4)  Research project involvement (describe briefly title of research
project - if any - and special research interests*)*:*









* *

*5)  I am prepared to share my experiences in a short presentation on the
following topic related to the course theme:*











*Please submit this filled in application form as an attachment by e-mail
to:*

*<staffan.bergstrom at ki.se> at the latest on Friday 1st of May 2009. All
inquiries about the course can be sent to the same address. *

* *

*You can also fax this form filled in to:*

* *

*Professor Staffan Bergström, IHCAR/Karolinska Institutet, Stockholm, fax
+46-8-31 15 90*

* *

*GENERAL INFORMATION TO ALL APPLICANTS: Please note that all applicants have
to plan to get financial coverage from home setting to Stockholm, capital of
Sweden. From there everything will paid by the course organizers during the
period August 17-30, 2009, including travel in Sweden from Stockholm to
course venue in Gotland, insurance fee, all costs for accommodation and
meals, tuition fee, course material like books and handouts etc.*
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