Task sharing within a managed clinical network to improve child health in Malawi
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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.
O'Hare , B A-M , Phiri , A , Lang , H-J , Friesen , H , Kennedy , N , Kawaza , K , Jana , C E , Mulwafu , W , Heikens , G T & Mipando , M 2015 , ' Task sharing within a managed clinical network to improve child health in Malawi ' BMC Human Resources for Health , vol 13 , 60 . DOI: 10.1186/s12960-015-0053-z
BMC Human Resources for Health
© 2015 O'Hare et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The Ministry of Health, Malawi, for its full support and collaboration during the development and implementation of this programme, including providing salaries for MOH staff during training. Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH for scholarships for BSc for CO PCH 2013–2014 intake and the salary of a paediatrician to provide training to this cadre. University of St Andrews Global Health Implementation programme for funding BSc PCH 2013–2017. University of Edinburgh for funding BSc PCH 2013–2016. The Scottish Government for funding the virtual learning environment for this cadre. Nchima Trust for funding BSc PCH 2014 intake. ELMA Philanthropies for funding MMED scholarships for specialist paediatricians. ELMA Philanthropies for funding BSc 2015–2018 intake, funding for supervision and mentoring visits