Menu
Menu
Menu
Menu
Objectives: The Enhancing Human Resources and Use of Appropriate Training for Maternal and Perinatal Survival in sub-Saharan Africa (ETATMBA) project is training non-physician clinicians as advanced clinical leaders in emergency maternal and newborn care in Tanzania and Malawi. The main aims of this process evaluation were to explore the implementation of the programme of training in Tanzania, how it was received, how or if the training has been implemented into practice and the challenges faced along the way. Design: Qualitative interviews with trainees, trainers, district officers and others exploring the application of the training into practice. Participants: During late 2010 and 2011, 36 trainees including 19 assistant medical officers one senior clinical officer and 16 nurse midwives/nurses (anaesthesia) were recruited from districts across rural Tanzania and invited to join the ETATMBA training programme. Results: Trainees (n=36) completed the training returning to 17 facilities, two left and one died shortly after training. Of the remaining trainees, 27 were interviewed at their health facility. Training was well received and knowledge and skills were increased. There were a number of challenges faced by trainees, not least that their new skills could not be practised because the facilities they returned to were not upgraded. Nonetheless, there is evidence that the training is having an effect locally on health outcomes, like maternal and neonatal mortality, and the trainees are sharing their new knowledge and skills with others. Conclusions: The outcome of this evaluation is encouraging but highlights that there are many ongoing challenges relating to infrastructure (including appropriate facilities, electricity and water) and the availability of basic supplies and drugs. This cadre of workers is a dedicated and valuable resource that can make a difference, which with better support could make a greater contribution to healthcare in the country.
A qualitative process evaluation (interviews) exploring the implementation and acceptability of the ETATMBA training programme from the perspective of a number of stakeholders including the trainees, the trainees’ district medical officers (DMOs), colleagues (whom they have cascaded ETATMBA skills to) and their trainers. Evidence of changing clinical practice was also explored. The research team was mainly composed of Research Scientist from the Ifakara Health Institute (IHI) Dar es Salaam, Tanzania. The primary data collection team consisted of two local research assistants (AS and FM) based at IHI. Both of the research assistants had great experience in qualitative research. The principal investigator at the IHI (GM) gave support to the local team while management/oversight was provided by DRE from Warwick, UK. During late 2010, early 2011, 36 trainees (AMOs and nurse midwives/nurses (anaesthesia)) were recruited from districts across Tanzania and invited to undertake the ETATMBA training programme (see web appendix for more information).1 While there was some attrition (eg, withdrawal from the training), the remaining trainees represent the sample from which we invited all to participate in evaluation interviews. In addition, we identified a number of DMOs and cascadees to be involved in interviews from facilities where trainees had been working. A cascadee was a nurse, midwife, AMO or CO with whom ETATMBA trainees shared their ETATMBA skills and knowledge. We also purposively invited a number of the local training facilitators to be interviewed. As a first step, the researchers identified the facilities where trainees were based. A letter of invitation including an information sheet and a copy of a consent form was then sent via email to all trainees from the IHI. Second, letters and information to the DMOs were similarly emailed. The letter had two purposes: first to inform them about our research in general, and second to invite them to participate. A copy of the consent form was included. In recognition that Tanzania is a very large country and road access is at times problematic, the research team arranged a ‘grand tour’ of all of the included districts and health facilities. This was undertaken in January/February 2014. This limited the opportunities to carry out interviews with everyone. In all districts the researchers invited all of the available trainees, cascadees and DMOs for interview. The research team developed an interview guide prior to the ‘grand tour’ that was used in all interviews. It was designed to cover the whole experience surrounding the training and specifically pressed for actual examples as evidence of changing practice. It was not enough for the trainee in the interview to just to say ‘yes’ or ‘no’ when questioned about the training; we encouraged them to provide specific examples. The semistructured Interviews were carried out at or near the health facilities at mutually agreeable times and held in a quiet private room during the researcher’s visit; confidentiality was assured. The IHI researchers conducted most of the interviews in Kiswahili to ensure no loss of meaning in expressions. English is officially the second language in Tanzania but it is commonly spoken and all of the trainees have good levels of English; however, it was found that they were more comfortable using Kiswahili. There were no formal inclusion exclusion criteria for this evaluation as we were targeting specific populations. Those outside these groups were not invited. Interviews were digitally recorded, subject to the permission of each participant and, where transcribed, verbatim. Recordings were stored in a secure digital environment accessible only to members of the research team. Participants were not identified by name; instead, a participant code number was used to identify transcripts. Data were analysed using the Framework method described by Ritchie and Spencer13 and Pope and Mays14 (see box 1). * Adapted from Ritchie and Spencer.13 The computer package NVivo V.10 was used to facilitate this process. The data were coded by the local researchers (AS and FM). Researcher bias was minimised through regular cross-checking of data and findings by the members of the research team DRE in the UK provided validation of themes. We note here that analysis of the process evaluation data (the interviews) was carried out before and without the knowledge of results from the quantitative studies (which will be reported elsewhere). Quotations are used as exemplars of themes. Each quotation has an identifier. The ‘ETATMBA trainer’ is identified thus, as are the three Obstetricians. Trainees are identified as T, followed by their profession, for example, NPC/AC, NA (anaesthetic nurse), NMW (nurse midwife) and finally a number (1–27). Cascadees (those who have received training from our trainees) are identified by CA and a number (1–12). DMOs and doctors in charge are identified as managers (MA) and a number (1–5). The study was reviewed and approved by the Biomedical Research Ethics Committee (BREC) at the University of Warwick, UK (REGO-2013-572) and The National Institute for Medical Research, Institutional review board, Dar es Salaam, Tanzania (no.35, dated 9 March 2012).
N/A
