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.authorEliah, Edsonen_ZA
dc.contributor.authorLewallen, Susanen_ZA
dc.contributor.authorKalua, Khumboen_ZA
dc.contributor.authorCourtright, Paulen_ZA
dc.contributor.authorGichangi, Michaelen_ZA
dc.contributor.authorBassett, Kenen_ZA
dc.date.accessioned2015-10-30T09:29:56Z
dc.date.available2015-10-30T09:29:56Z
dc.date.issued2014en_ZA
dc.description.abstractBACKGROUND: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.identifier.apacitationEliah, 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. <i>Human Resources for Health</i>, http://hdl.handle.net/11427/14506en_ZA
dc.identifier.chicagocitationEliah, Edson, Susan Lewallen, Khumbo Kalua, Paul Courtright, Michael Gichangi, and Ken Bassett "Task shifting for cataract surgery in eastern Africa: productivity and attrition of non-physician cataract surgeons in Kenya, Malawi and Tanzania." <i>Human Resources for Health</i> (2014) http://hdl.handle.net/11427/14506en_ZA
dc.identifier.citationEliah, 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.ris TY - Journal Article AU - Eliah, Edson AU - Lewallen, Susan AU - Kalua, Khumbo AU - Courtright, Paul AU - Gichangi, Michael AU - Bassett, Ken AB - 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. DA - 2014 DB - OpenUCT DO - 10.1186/1478-4491-12-S1-S4 DP - University of Cape Town J1 - Human Resources for Health LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Task shifting for cataract surgery in eastern Africa: productivity and attrition of non-physician cataract surgeons in Kenya, Malawi and Tanzania TI - Task shifting for cataract surgery in eastern Africa: productivity and attrition of non-physician cataract surgeons in Kenya, Malawi and Tanzania UR - http://hdl.handle.net/11427/14506 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14506
dc.identifier.urihttp://dx.doi.org/10.1186/1478-4491-12-S1-S4
dc.identifier.vancouvercitationEliah E, Lewallen S, Kalua K, Courtright P, Gichangi M, Bassett K. 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. 2014; http://hdl.handle.net/11427/14506.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDivision of Ophthalmologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2014 Eliah et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourceHuman Resources for Healthen_ZA
dc.source.urihttp://www.human-resources-health.com/en_ZA
dc.subject.othercataracten_ZA
dc.subject.othertask shiftingen_ZA
dc.subject.othercataract surgeonsen_ZA
dc.subject.otherhuman resourcesen_ZA
dc.subject.otherKenyaen_ZA
dc.subject.otherMalawien_ZA
dc.subject.otherTanzaniaen_ZA
dc.titleTask shifting for cataract surgery in eastern Africa: productivity and attrition of non-physician cataract surgeons in Kenya, Malawi and Tanzaniaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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