[Re: https://www.hifa.org/dgroups-rss/publication-our-paper-our-12-year-progr... ]
Dear David,
Many thanks for your message and for alerting us to your new publication:
CITATION: Dahn, B., MacDonald, R., Dolo, O.W. et al. Reducing maternal, neonatal, and child mortality and improving quality of health care through a national task-shifting program for public hospitals in Liberia. Hum Resour Health 23, 39 (2025). https://doi.org/10.1186/s12960-025-01001-7
ABSTRACT
Background
Contributing to the high hospital-based maternal, neonatal, and child mortalities in low resource countries and conflict zones is a shortage of health workers, especially physicians. Training programs, conducted over 12 years, have enhanced the skills of midwives, and nurses, to provide high quality, hospital-based, care to pregnant women, newborn infants, children, and adolescents.
Methods
A task-shifting partnership between the Ministry of Health, World Health Organisation, United Nations Population Fund, United Nations Children’s Emergency Fund and the charity Maternal and Childhealth Advocacy International was established in 2012. Rural county health teams selected 37 midwives, 20 nurses, 1 nurse/midwife and 2 physician assistants, for advanced training. They were appointed following a written examination and interview. Obstetric clinician trainees underwent a 3-year programme, which included operative procedures. The training programs for neonatal and paediatric clinician trainees were 2 years and 2.3 years, respectively. Training consisted of apprenticeship-based training and distance learning. It was delivered by Liberian and international specialists. Trainee competence was established by continuous clinical assessment, oral, and written clinical examinations. The programme also upgraded hospital buildings and provided essential equipment and drugs.
Results
59 trainees completed training, 2 failed and 57 qualified in final examinations. 27 are working as obstetric clinicians, 15 are working as neonatal clinicians, and 11 are working as paediatric clinicians. Therefore, 53 are working in 18 hospitals and 4 Comprehensive Emergency Obstetric and Newborn Care (CEmONC) facilities. Obstetric clinicians manage major obstetric emergencies. They perform abdominal surgery, including the management of ruptured ectopic pregnancy and basic and complicated caesarean sections. Neonatal clinicians resuscitate and care for sick and premature babies to WHO Special Care Level 2. Paediatric clinicians manage the main paediatric emergencies that contribute to high mortality. Before the arrival of the international trainer, paediatric mortality in the training hospital was 9.5% and was 4.1% in the final year of training.
Conclusions
This task shifting programme in Liberia has shown that midwives and nurses can be trained to provide safe and effective hospital care for pregnant women, newborn infants and children. This approach is one solution to the health workforce problem in low resource and conflict settings.
The full text concludes: This task shifting program in Liberia has shown that midwives and nurses can achieve comprehensive levels of clinical practice and provide safe and effective emergency hospital care for pregnant women, neonates, children, and adolescents.
This approach is one solution to the health workforce problem in low resource and conflict areas. It has the potential to be implemented in other countries and for settings involving refugees or the internally displaced.
You ask: "Do you think that the task shifting approach might be of value to your country or other countries with which you are associated?"
I have not read the full paper, but from the abstract I understand that mid-level workers were selected for advanced training to become 'obstetric, neonatal and paediatric clinicians', who would then take on part of the workload of medically qualified obstetricians, neonatologists and paediatricians to 'work with and assist other health workers to strengthen the emergency care normally offered in hospitals or in the community to pregnant women, babies and children'.
It would be very interesting to hear from other HIFA members about similar (or different) approaches to maintaining quality obsttetric, neonatal and paediatric services in situations where there is a profound lack of medically qualified staff.
Another question would be: What has been done in terms of systematic review of different approaches to maintaining quality? If any HIFA members can help us identify such reviews this would eb very helpful.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org