Task Analysis Study of Multiple Cadres in Provision of Maternal and Newborn Health Services in Ethiopia

Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Midwives, doctors and nurses provide frontline maternal and newborn health (MNH) services in Ethiopia. Their availability and competence determines the ability of the health system to provide high impact interventions affecting achievement of Millennium Development Goals. Task analysis studies can identify needs and gaps in practice for health workforce strengthening interventions. We analyzed tasks of these cadres to understand frequency and perceived level of proficiency in providing MNH services.

Methodology: We conducted a cross-sectional study of midwives, doctors and nurses with work experience between 6 months and 4 years in the Ethiopian public health system. The geographically representative sample included 138 midwives, 191 doctors and 223 nurses surveyed using a structured questionnaire. Participants rated specific MNH tasks on frequency completed and ability to perform. Descriptive statistics were used to identify needs and gaps for health system strengthening.

Results: Midwives provide MNH care most often, but had low performance ratings for a number of tasks that are critical to rural health services in Ethiopia, including manual vacuum aspiration, management of ectopic pregnancy and management of labor augmentation/induction. Doctors provide MNH services infrequently, and a significant percentage said they were unable to perform contraceptive implants, IUCDs, and vacuum extraction. Nurses provide MNH services infrequently, though they are often the first line health workers. A large percentage of nurses were unable to insert and remove IUCD and contraceptive implants, perform vacuum extraction, assist complicated deliveries, provide post-abortion care or monitor labor with partograph.

Conclusions:   Midwives are the principal MNH service providers with doctors and nurses providing MNH services less frequently. Midwives, doctors and nurses alike reported important competence gaps, with the deficit most pronounced among nurses. The task analysis data will be used to address the critical competence gaps for all cadres.