Browsing by Subject "Task shifting"

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    Anesthesia care task sharing a clinical audit for the anesthesia care provided by anesthesia technologists in Wad Medani,Central Sudan
    (2025) Mohamed, Alaa; Alphonsus, Christella; Mahjoub, Sami
    Introduction: The bachelor's degree in anaesthesia sciences program was implemented in Sudan in 1998 to alleviate the shortage of anaesthesiologists while minimizing the anaesthesia related complications of anaesthesia technicians' practice. In the absence of a defined scope of practice and a lack of financial and legal protection, practitioners are leaving their anaesthesia technology careers in Sudan in search of more secure careers, which has resulted in a noticeable gap in anaesthesia practice in Wad Medani, Gezira State. This study was conducted to determine the proportion of anaesthesia care tasks that were carried out by the anaesthesia technologists at four public referral hospitals in Wad Medani, Sudan. Methods: The study was a three-month cross-sectional observational clinical audit of anaesthetic services at four Gezira State Ministry of Health tertiary referral hospitals and included a number of 1559 patients. Data was gathered to describe the perioperative anaesthetic care tasks provided to surgical patients undergoing emergency or elective procedures through a questionnaire that was designed based on the definition of the American Society of Anaesthesiologists of the anaesthesia care tasks. The study began on November 3rd, 2022, and lasted three months, ending on February 2nd, 2023. Results: The analysed data showed an average of 18 cases per day. Out of the total 1559 surgical anaesthesia cases in Wad Medani, 718 (46%) of cases were carried out by anaesthesia technologists without the presence of supervising anaesthesiologists. A percentage of 65.2 of these cases were spinal anaesthesia while general anaesthesia and sedation comprised 25.6% and 9.2% respectively. In the presence of supervising anaesthesiologist, anaesthesia technologists performed over 80% of the anaesthesia care tasks. Conclusions: Anaesthesia technologists make a substantial contribution to Anaesthesia services in Wad Medani. Our results demonstrated that a considerable proportion of Anaesthesia procedures are carried out without any kind of anaesthesiologists supervision. Guidelines and protocols should be developed and implemented to govern anaesthesia practice given the resource constraints in this setting. Regular training on safe anaesthesia practice should be applied. Further research is needed on to assess the provision of anaesthesia care and the extent of surgical delay in regions of displacement.
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    Exploring effort–reward imbalance and professional quality of life among health workers in Cape Town, South Africa: a mixed-methods study
    (2022-03-01) Jensen, N; Lund, C; Abrahams, Z
    Background In the context of a growing appreciation for the wellbeing of the health workforce as the foundation of high-quality, sustainable health systems, this paper presents findings from two complementary studies to explore occupational stress and professional quality of life among health workers that were conducted in preparation for a task-shifting intervention to improve antenatal mental health services in Cape Town. Methods This mixed-methods, cross-sectional study was conducted in public sector Midwife Obstetric Units and associated Non-Profit Organisations in Cape Town. Semi-structured interviews and a quantitative survey were conducted among facility-and community-based professional and lay health workers. The survey included demographic as well as effort–reward imbalance (ERI) and professional quality of life (PROQOL) questionnaires to examine overall levels of work-related psychosocial stress and professional quality of life, as well as differences between lay and professional health workers. Qualitative data was analysed using a thematic content analysis approach. Quantitative data was analysed using STATA 12. Results Findings from 37 qualitative interviews highlighted the difficult working conditions and often limited reward and support structures experienced by health workers. Corroborating these findings, our quantitative survey of 165 professional and lay health workers revealed that most health workers experienced a mismatch between efforts spent and rewards gained at work (61.1% of professional and 70.2% of lay health workers; p = 0.302). There were few statistically significant differences in ERI and PROQOL scores between professional and lay health workers. Although Compassion Satisfaction was high for all health worker groups, lay health workers also showed elevated levels of burnout and compassion fatigue, with community-based health workers particularly affected. Conclusions Findings of this study add to the existing evidence base on adverse working conditions faced by South African public-sector health workers that should be taken into consideration as national and local governments seek to ‘re-engineer’ South Africa’s Primary Health Care system. Furthermore, they also highlight the importance of taking into consideration the wellbeing of health workers themselves to develop interventions that can sustainably foster resilient and high-quality health systems.
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    Piloting a mental health training programme for community health workers in South Africa: an exploration of changes in knowledge, confidence and attitudes
    (BioMed Central, 2018-06-14) Sibeko, Goodman; Milligan, Peter D; Roelofse, Marinda; Molefe, Lezel; Jonker, Deborah; Ipser, Jonathan; Lund, Crick; Stein, Dan J
    Background There is a shortage of trained mental health workers in spite of the significant contribution of psychiatric disorders to the global disease burden. Task shifting, through the delegation of health care tasks to less specialised health workers such as community health workers (CHWs), is a promising approach to address the human resource shortage. CHWs in the Western Cape province of South Africa provide comprehensive chronic support which includes that for mental illness, but have thus far not received standardized mental health training. It is unknown whether a structured mental health training programme would be acceptable and feasible, and result improved knowledge, confidence and attitudes amongst CHWs. Methods We developed and piloted a mental health training programme for CHWs, in line with the UNESCO guidelines; the WHO Mental Health Gap Action Programme and the South African National framework for CHW training. In our quasi-experimental (before-after) cohort intervention study we measured outcomes at the start and end of training included: 1) Mental health knowledge, measured through the use of case vignettes and the Mental Health Knowledge Schedule; 2) confidence, measured with the Mental Health Nurse Clinical Confidence Scale; and 3) attitudes, measured with the Community Attitudes towards the Mentally Ill Scale. Knowledge measures were repeated 3 months later. Acceptability data were obtained from daily evaluation questionnaires and a training evaluation questionnaire, while feasibility was measured by participant attendance at training sessions. Results Fifty-eight CHWs received the training, with most (n = 56, 97.0%) attending at least 7 of the 8 sessions. Most participants (n = 29, 63.04%) demonstrated significant improvement in knowledge, which was sustained at 3-months. There was significant improvement in confidence, along with changes in attitude, indicating improved benevolence, reduced social restrictiveness, and increased tolerance to rehabilitation of the mentally ill in the community but there was no change in authoritarian attitudes. The training was acceptable and feasible. Conclusions Mental health training was successful in improving knowledge, confidence and attitudes amongst trained CHWs. The training was acceptable and feasible. Further controlled studies are required to evaluate the impact of such training on patient health outcomes. Trial registration PACTR PACTR201610001834198 , Registered 26 October 2016.