Supportive Supervision, Clinical Mentoring and Continuing Medical Education for Non-Physician Clinicians Providing Comprehensive Emergency Obstetric Care in Three Regions of Tanzania

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: Since 2008, the World Lung Foundation’s (WLF) Maternal Health Program, together with the Government, has established comprehensive emergency obstetric and neonatal care (CEmONC) in 10 rural health centers and five hospitals in three regions of Tanzania. The Program operates on two basic principles: that is decentralizing CEmONC services to the health center level; and task-shifting of life serving skills to lower cadres.

Methodology: Project-supported facilities were equipped to provide CEmONC and over 100 Assistant Medical Officers, Nurse Midwives, and Clinical Officers competency-based trained on CEmONC. These facilities receive routine monthly supportive supervision and mentoring visits, participate in weekly teleconferences, attended CME workshops on topics such as assisted vaginal delivery, neonatal resuscitation and obstetric anaesthesia, have access to free clinical advice 24/7 from obstetricians through an emergency hotline and can take online courses via an e-learning platform.

Results: In 2014, the Centers for Disease Control (CDC) conducted an evaluation in Kigoma, and found that between 2011 and 2013, the met need for EmONC increased by 17% (from 36% to 42%) and the direct obstetric case fatality rate fell from 2.3% to 1.3%. Project-supported facilities which comprised only 7% of the facilities in the region, provided 74% of the met need. Clinical audits conducted in the facilities by support the findings that quality of care has improved. WLF’s approach to improving the availability of CEmONC has recently been incorporated into the Government of Tanzania’s plan for maternal mortality reduction (Big Results Now).

Conclusion: High-quality supportive supervision, mentoring and CME are essential to building a network of competent and confident health professionals who can provide quality EmONC in rural areas, leading to reduction of maternal and newborn deaths and disabilities.