Task shifting for cataract surgery in eastern Africa: productivity and attrition of non-physician cataract surgeons in Kenya, Malawi and Tanzania

 

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dc.contributor.author Eliah, Edson en_ZA
dc.contributor.author Lewallen, Susan en_ZA
dc.contributor.author Kalua, Khumbo en_ZA
dc.contributor.author Courtright, Paul en_ZA
dc.contributor.author Gichangi, Michael en_ZA
dc.contributor.author Bassett, Ken en_ZA
dc.date.accessioned 2015-10-30T09:29:56Z
dc.date.available 2015-10-30T09:29:56Z
dc.date.issued 2014 en_ZA
dc.identifier.citation Eliah, E., Lewallen, S., Kalua, K., Courtright, P., Gichangi, M., & Bassett, K. (2014). Task shifting for cataract surgery in eastern Africa: productivity and attrition of non-physician cataract surgeons in Kenya, Malawi and Tanzania. Human resources for health, 12(Suppl 1), S4. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/14506
dc.identifier.uri http://dx.doi.org/10.1186/1478-4491-12-S1-S4
dc.description.abstract BACKGROUND:This project examined the surgical productivity and attrition of non-physician cataract surgeons (NPCSs) in Tanzania, Malawi, and Kenya. METHODS: Baseline (2008-9) data on training, support, and productivity (annual cataract surgery rate) were collected from officially trained NPCSs using mailed questionnaires followed by telephone interviews. Telephone interviews were used to collect follow-up data annually on productivity and semi-annually on attrition. A detailed telephone interview was conducted if a surgeon left his/her post. Data were entered into and analysed using STATA. RESULTS: Among the 135 NPCSs, 129 were enrolled in the study (Kenya 88, Tanzania 38, and Malawi 3) mean age 42 years; average time since completing training 6.6 years. Employment was in District 44%, Regional 24% or mission/ private 32% hospitals. Small incision cataract surgery was practiced by 38% of the NPCSs. The mean cataract surgery rate was 188/year, median 76 (range 0-1700). For 39 (31%) NPCSs their surgical rate was more than 200/year. Approximately 22% in Kenya and 25% in Tanzania had years where the cataract surgical rate was zero. About 11% of the surgeons had no support staff.Factors significantly associated with increased productivity were: 1) located at a regional or private/mission hospital compared to a district hospital (OR = 8.26; 95 % CI 2.89 - 23.81); 2) 3 or more nurses in the eye unit (OR = 8.69; 95% CI 3.27-23.15); 3) 3 or more cataract surgical sets (OR = 3.26; 95% CI 1.48-7.16); 4) a separate eye theatre (OR = 5.41; 95% CI 2.15-13.65); 5) a surgical outreach program (OR = 4.44; 95% CI 1.88-10.52); and 6) providing transport for patients to hospital (OR = 6.39; 95% CI 2.62-15.59). The associations were similar for baseline and follow-up assessments. Attrition during the 3 years occurred in 13 surgeons (10.3%) and was due to retirement or promotion to administration. CONCLUSIONS: High quality training is necessary but not sufficient to result in cataract surgical activity that meets population needs and maintains surgical skill. Needed are supporting institutions and staff, functioning equipment and programs to recruit and transport patients. en_ZA
dc.language.iso eng en_ZA
dc.publisher BioMed Central Ltd en_ZA
dc.rights This is an open access article distributed under the terms of the Creative Commons Attribution License en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source Human Resources for Health en_ZA
dc.source.uri http://www.human-resources-health.com/ en_ZA
dc.subject.other cataract en_ZA
dc.subject.other task shifting en_ZA
dc.subject.other cataract surgeons en_ZA
dc.subject.other human resources en_ZA
dc.subject.other Kenya en_ZA
dc.subject.other Malawi en_ZA
dc.subject.other Tanzania en_ZA
dc.title Task shifting for cataract surgery in eastern Africa: productivity and attrition of non-physician cataract surgeons in Kenya, Malawi and Tanzania en_ZA
dc.type Journal Article en_ZA
dc.rights.holder 2014 Eliah et al; licensee BioMed Central Ltd. en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Division of Ophthalmology en_ZA
uct.type.filetype Text
uct.type.filetype Image


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This is an open access article distributed under the terms of the Creative Commons Attribution License Except where otherwise noted, this item's license is described as This is an open access article distributed under the terms of the Creative Commons Attribution License