Task sharing within a managed clinical network to improve child health in Malawi

Human Resources for Health

Mwapatsa Mipando³  Geert T. Heikens³  Wakisa Mulwafu³  George Chirambo⁴  Collins E. Jana⁴  Kondwani Kawaza⁵  Neil Kennedy⁵  Hanny Friesen⁵  Hans-Joerg Lang²  Ajib Phiri⁵  Bernadette O’Hare¹ 

[1] The University of St Andrews, Saint Andrews, UK;Médecins sans Frontières, Allemagne, France;College of Medicine, Blantyre, Malawi;Department of Basic Medical Sciences, College of Medicine, Blantyre, Malawi;Department of Paediatrics and Child Health, College of Medicine, Blantyre, Malawi

关键词: Non-physician clinicians;    Paediatrics;    Child health;    Sub-Saharan Africa;    Task sharing;    Task shifting;    Managed clinical networks;   

Others  :  1221226
DOI  :  10.1186/s12960-015-0053-z

 received in 2014-11-12, accepted in 2015-06-27,  发布年份 2015

【 摘 要 】

Background

Eighty per cent of Malawi’s 8 million children live in rural areas, and there is an extensive tiered health system infrastructure from village health clinics to district hospitals which refers patients to one of the four central hospitals. The clinics and district hospitals are staffed by nurses, non-physician clinicians and recently qualified doctors. There are 16 paediatric specialists working in two of the four central hospitals which serve the urban population as well as accepting referrals from district hospitals. In order to provide expert paediatric care as close to home as possible, we describe our plan to task share within a managed clinical network and our hypothesis that this will improve paediatric care and child health.

Presentation of the hypothesis

Managed clinical networks have been found to improve equity of care in rural districts and to ensure that the correct care is provided as close to home as possible. A network for paediatric care in Malawi with mentoring of non-physician clinicians based in a district hospital by paediatricians based at the central hospitals will establish and sustain clinical referral pathways in both directions. Ultimately, the plan envisages four managed paediatric clinical networks, each radiating from one of Malawi’s four central hospitals and covering the entire country. This model of task sharing within four hub-and-spoke networks may facilitate wider dissemination of scarce expertise and improve child healthcare in Malawi close to the child’s home.

Testing the hypothesis

Funding has been secured to train sufficient personnel to staff all central and district hospitals in Malawi with teams of paediatric specialists in the central hospitals and specialist non-physician clinicians in each government district hospital. The hypothesis will be tested using a natural experiment model. Data routinely collected by the Ministry of Health will be corroborated at the district. This will include case fatality rates for common childhood illness, perinatal mortality and process indicators. Data from different districts will be compared at baseline and annually until 2020 as the specialists of both cadres take up posts.

Implications of the hypothesis

If a managed clinical network improves child healthcare in Malawi, it may be a potential model for the other countries in sub-Saharan Africa with similar cadres in their healthcare system and face similar challenges in terms of scarcity of specialists.

【 授权许可】

   
2015 O'Hare et al.

【 参考文献 】

• [1]Bailey N, Mandeville KL, Rhodes T, Mipando M, Muula AS. Postgraduate career intentions of medical students and recent graduates in Malawi: a qualitative interview study. BMC Med Educ. 2012; 12(1):87.
• [2]Mueller DH, Lungu D, Acharya A, Palmer N. Constraints to implementing the Essential Health Package in Malawi. PLoS One. 2011; 6(6):e20741.
• [3]Zere E, Moeti M, Kirigia J, Mwase T, Kataika E. Equity in health and healthcare in Malawi: analysis of trends. BMC Public Health. 2007; 7:78.
• [4]Mathanga DP, Bowie C. Malaria control in Malawi: are the poor being served? Int J Equity Health. 2007; 6:22.
• [5]Jahn A, Floyd S, McGrath N, Crampin AC, Kachiwanda L, Mwinuka V et al.. Child mortality in rural Malawi: HIV closes the survival gap between the socio-economic strata. PLoS One. 2010; 5:e11320.
• [6]Mandeville KL, Ulaya G, Lagarde M, Gwesele L, Dzowela T, Hanson K et al.. Early career retention of Malawian medical graduates: a retrospective cohort study. Trop Med Int Health. 2014; 00(00):1-9.
• [7]Zijlstra EE, Broadhead RL. The College of Medicine in the Republic of Malawi: towards sustainable staff development. Hum Resour Health. 2007; 5:10.
• [8]Mullan F, Frehywot S. Non-physician clinicians in 47 sub-Saharan African countries. Lancet. 2007; 370(9605):2158-63.
• [9]Muula AS. Case for clinical officers and medical assistants in Malawi. Croat Med J. 2009; 50(1):77-8.
• [10]Baker CD, Lorimer AR. Cardiology: the development of a managed clinical network. BMJ. 2000; 321(7269):1152-3.
• [11]RCPCH. Bringing networks to life - an RCPCH guide to implementing clinical networks [Internet]. 2012. Available from:. http://www. rcpch.ac.uk/networks webcite
• [12]Cropper S, Hopper A, Spencer S. Managed clinical networks. Leading article. Arch Dis Child. 2002; 87(1):241-2.
• [13]Mulwafu W. Thomas Elliot Nyirenda JJF, Bem C, Mlumbe K, Chitule J. Initiating and developing clinical services, training and research in a low resource setting: the Malawi ENT experience. Trop Doct. 2014; 44(3):135-9.
• [14]Lega F, Sartirana M. Managed clinical networks: scope, evidence and feasibility. Int J Clin Pract. 2011; 65(7):7.
• [15]COMREC. College of Medicine Research Ethics Committee [Internet]. 2015. Available from:. http://www. medcol.mw/comrec/ webcite