Task shifting for cataract surgery in eastern Africa: productivity and attrition of non-physician cataract surgeons in Kenya, Malawi and Tanzania

Human Resources for Health

Research

Khumbo Kalua¹  Ken Bassett²  Michael Gichangi³  Edson Eliah⁴  Susan Lewallen⁵  Paul Courtright⁵ 

[1] Blantyre Institute for Community Ophthalmology and Ministry of Health, Lions Sight first Eye Hospital, Blantyre, P.O. BOX E180 Post Dot Net, Blantyre, Malawi;Department of Ophthalmology, University of Malawi College of Medicine, P/Bag 360, Blantyre, Malawi;British Columbia Centre for Epidemiologic and International Ophthalmology, University of British Columbia, Vancouver, BC, Canada, V5Z 3N9;Division of ophthalmic services, Ministry of Health, PO Box 43319, Nairobi, Kenya;Kilimanjaro Centre for Community Ophthalmology, P.O. Box 2265, Moshi, Tanzania;Kilimanjaro Centre for Community Ophthalmology, P.O. Box 2265, Moshi, Tanzania;Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, South Africa;

关键词: cataract;    task shifting;    cataract surgeons;    human resources;    Kenya;    Malawi;    Tanzania;    cataracte;    délégation des tâches;    chirurgiens de la cataracte;    ressources humaines;    Kenya;    Malawi;    Tanzanie;   

DOI  :  10.1186/1478-4491-12-S1-S4

来源: Springer

【 摘 要 】

BackgroundThis project examined the surgical productivity and attrition of non-physician cataract surgeons (NPCSs) in Tanzania, Malawi, and Kenya.MethodsBaseline (2008-9) data on training, support, and productivity (annual cataract surgery rate) were collected from officially trained NPCSs using mailed questionnaires followed by telephone interviews. Telephone interviews were used to collect follow-up data annually on productivity and semi-annually on attrition. A detailed telephone interview was conducted if a surgeon left his/her post. Data were entered into and analysed using STATA.ResultsAmong the 135 NPCSs, 129 were enrolled in the study (Kenya 88, Tanzania 38, and Malawi 3) mean age 42 years; average time since completing training 6.6 years. Employment was in District 44%, Regional 24% or mission/ private 32% hospitals. Small incision cataract surgery was practiced by 38% of the NPCSs. The mean cataract surgery rate was 188/year, median 76 (range 0-1700). For 39 (31%) NPCSs their surgical rate was more than 200/year. Approximately 22% in Kenya and 25% in Tanzania had years where the cataract surgical rate was zero. About 11% of the surgeons had no support staff.Factors significantly associated with increased productivity were: 1) located at a regional or private/mission hospital compared to a district hospital (OR = 8.26; 95 % CI 2.89 – 23.81); 2) 3 or more nurses in the eye unit (OR = 8.69; 95% CI 3.27-23.15); 3) 3 or more cataract surgical sets (OR = 3.26; 95% CI 1.48-7.16); 4) a separate eye theatre (OR = 5.41; 95% CI 2.15-13.65); 5) a surgical outreach program (OR = 4.44; 95% CI 1.88-10.52); and 6) providing transport for patients to hospital (OR = 6.39; 95% CI 2.62-15.59). The associations were similar for baseline and follow-up assessments. Attrition during the 3 years occurred in 13 surgeons (10.3%) and was due to retirement or promotion to administration.ConclusionsHigh quality training is necessary but not sufficient to result in cataract surgical activity that meets population needs and maintains surgical skill. Needed are supporting institutions and staff, functioning equipment and programs to recruit and transport patients.

【 授权许可】

CC BY   
© Eliah et al; licensee BioMed Central Ltd. 2014