Task sharing and performance of Caesarean section by the Assistant Medical Officers in Tanzania: What have we learned?

Abstract

Background: Since the 1960s, Tanzania adopted the task shifting which was later termed task-sharing strategy in efforts to address the critical shortage of health workforce. However, poor maternal health indicators have remained a big challenge despite this strategy having introduced mid-level cadres (Assistant Medical Officers) capable of performing roles that otherwise were performed by doctors at the district level.
Objective: To analyse lessons from the performance of Caesarean section by Assistant Medical Officers (AMOs) in Tanzania as part of the task sharing strategy.
Methods: An exploratory qualitative case study was carried out where 10 key informant interviews with AMOs and 4 focused group discussions with AMO trainees were conducted in 4 selected districts and 2 AMO training schools in Tanzania. With the aid of Nvivo10 qualitative software, content analysis was performed to the gathered data.
Results: Performance of the Caesarean section by the AMOs is motivated by the support from various stakeholders towards improving the performance of Caesarean section. Frustrating work environment and poor incentive system are major demotivators to the performance of the Caesarean section by the AMOs.
Conclusions: More than 5 decades since the introduction of AMOs through task sharing, the performance of caesarean section by these cadres face more demotivators than the motivators. Efforts should be focused on improving the work environment and provision of appropriate incentives to the AMOs. Also, more stakeholders should be engaged to support the performance of caesarean section by the AMOs for realisation of the objectives of task sharing strategy.