Dr Shafique Pirani University of British Columbia Project Director
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What aspects of task shifting are working well and can we build upon and replicate these achievements in Uganda? Dr Shafique Pirani University of British Columbia Project Director Uganda Sustainable Clubfoot Care Project
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What aspects of task shifting are working well and can we build upon and replicate these achievements in Uganda?. Dr Shafique Pirani University of British Columbia Project Director Uganda Sustainable Clubfoot Care Project. Problem - A global health workforce crisis . - PowerPoint PPT Presentation
Transcript of Dr Shafique Pirani University of British Columbia Project Director
What aspects of task shifting are working well and can we build upon and replicate these achievements
in Uganda?
Dr Shafique Pirani
University of British Columbia
Project Director
Uganda Sustainable Clubfoot Care Project
Problem - A global health workforce crisis
• World facing a chronic shortage of trained health workers.
• Global health workforce deficit of more than four million
• Shortages critical in developing nations
• Malawi - one doctor for every 100,000 people.
Task Shifting - Global Recommendations and Guidelines, WHO 2006
Problem - A global health workforce crisis
• Direct correlation between numbers of people with access to health services and the numbers of health-service providers.
• Crisis impedes ability for “enough people, with the right skills, in the right place”
• Need to strengthen health systems to meet commitments of Millennium Development Goals
Task Shifting - Global Recommendations and Guidelines, WHO 2006
Task Shifting: A Strategy to address the problem of a chronic shortage of trained healthcare workers
Task shifting
“A rational redistribution of tasks among health workforce teams whereby specific tasks are moved, where appropriate, to health workers with shorter training and fewer qualifications so as to make more efficient use of existing human resources and ease bottlenecks in service delivery.”
Task Shifting - Global Recommendations and Guidelines, WHO 2006
Task shifting not new
Many nations have a history of health care provision by staff who are not trained to be physicians, but who are capable of many of the diagnostic and clinical functions of medical doctors.
Barefoot doctors (China)
Officiers de sante (France)
Feldshers (Russia)
Orthopaedic Officers, UgandaOrthopaedic Clinical Officers, Malawi
Non specialist surgeonMedical Officers at District Hospital without Surgeon
Non-physician surgeonsTechnicos De CirugiaNurses who have 3 yrs additional training in a program established in 1984.
? Safe? Effective? Cost? Sustainable
• 2071 caesarian deliveries• 46% by assistant med officer• 54% by specialists
• No differences in the indications for caesarean delivery• No differences in interventions associated with
caesarean delivery • Significant difference in superficial wound separation
due to haematoma, which was slightly more common (0.35% vs 0.05%) in the group operated on by assistant medical officers
• 14 assistant medical officers (1995)• 10,258 surgical operations• 70% emergency (0.4% postoperative mortality)• 30% elective (0.1% postoperative mortality)
After 7 years• >90% of three graduating classes of tecnicos de
cirurgia stayed in rural areas• Not a single physician graduating in the same years
did so. Pereira et al (unpublished)
Productivity And Costs 2002
SpecialistSurgeon
Non-Physician Surgeon (technico)
Surgeries 5264 6914
Number of surgeons 47 53
C-sections per surgeon 102 117
Obstetric Hysterectomies per surgeon
4 7
Laparotomy per surgeon 6 7
Cost per surgery $144 $39
Guidelines for Task Shifting (borrowed from HIV/AIDS)
• Define Limits• Provide Training, Supervision and Referral Systems• Ensure Adequate Recognition and Remuneration• Develop Adapted Guidelines• Simplification• Engaging with Regulatory Frameworks and Professional
Bodies• Exploring Potential for Community Support
“To contribute to eliminating the neglected clubfoot as a significant cause of musculoskeletal disability and poverty in Uganda”
Good/Excellent
33%
Fair/Poor
67%
Reoperation rate 88%
The Ponseti Method
Dr Ignacio PonsetiUniversity of Iowa
ControlsPonseti
Good/Excellent
78%
Fair/Poor
22%
Good/Excellent
85%
Fair/Poor
15%
Task Shifting – Paramedicals can treat clubfeet
“… the Ponseti method of serial cast treatment can be employed successfully by appropriately trained healthcare professionals such as physiotherapists…”
Task Shifting – Paramedicals can treat clubfeet
“ We believe that the Ponseti technique is suitable for us by non-medical personnel….”
Engaging Regulatory Frameworks and Professional Bodies
Training and Supervision
Institutions Teaching
Medical Schools 4
Paramedical Schools 2
Nursing & midwifery Schools 32
Define Limits, Develop Adapted Guidelines
Clubfoot clinics in 36 hospitals
Opening Arua Hospital Clubfoot Clinic
Referral System
Screening for foot deformity at birth
‘I absconded from treatment because the kids father provided no support’
Mother
‘Traditionally, people think that there are unappeased spirits causing the problem.’
Practitioner treating clubfoot
Exploring Potential for Community Support: Ethnocultural survey of clubfoot in Uganda
Clubfoot clinics in 36 hospitals
Region 2006 2007 2008 2009
Central 155 171 209 232
Eastern 116 144 175 205
Northern
32 35 54 92
Western 106 135 170 204
Total 409 485 608 791
Children treated per year by region
Ex Africa Semper Aliquid NoviThere is always something new from Africa
Pliny the Elder, 77AD.
