Workforce Innovations to Expand the Capacity for Surgical Services

Authors: Staffan Bergström, Barbara McPake, Caetano Pereira, Delanyo Dovlo


The crisis in human resources in surgical health care is a major health system challenge in low-income countries. Innovative workforce solutions offer viable options to alleviating the consequences of these staff shortages. Task-shifting is a feasible strategy that should be seriously considered to address this crisis. Nonphysician clinicians (associate clinicians) perform approximately 90 percent of major emergency obstetric surgeries at remote hospitals in two countries investigated, Mozambique and Tanzania. In Mozambique, a comparison of the quality of care provided by physicians and that provided by nonphysician clinicians demonstrates no clinically significant differences in outcomes in major obstetric surgery. Challenges continue in terms of the development and implementation of training and regulatory mechanisms, and the expansion of the capacity for skills development and improvement, and supervision. Improved accuracy in preoperative decision making by different professional categories deserves a more specific approach. Medical doctors, who often demonstrate reluctance to the task-shifting of major surgery to mid-level providers, should realize that as physicians they can play an essential role in providing quality assurance and supervision. If they accept this role, they will contribute to enhancing the survival of the poorest people in rural areas, who currently lack such life-saving care.


327.05 KB