Training non-physician mid-level providers of care (associate clinicians) to perform caesarean sections in low-income countries

Best Pract Res Clin Obstet Gynaecol. 2015 Nov;29(8):1092-101. doi: 10.1016/j.bpobgyn.2015.03.016. Epub 2015 Mar 31.


Comprehensive emergency obstetric care including major surgery such as caesarean section is a major health system problem in rural areas of poor countries, where there are no doctors. Innovative trainings of mid-level workforce have now demonstrated viable, scientifically valid solutions. Delegation of major surgery to duly trained 'non-physician clinicians' - 'task shifting' - should be seriously considered to address the human resources crisis in poor countries to cope with current challenges to enhance maternal and neonatal survival. Nationwide, non-physician clinicians in Mozambique perform approximately 90% of caesarean sections at the district hospital level. A comparison between the outcomes of caesarean sections provided by this category and medical doctors, respectively, demonstrates no clinically significant differences. These mid-level providers have a remarkably high retention rate in rural areas (close to 90%). They are cost-effective, as their training and deployment is three times more cost-effective than that of medical doctors.

Keywords: Mozambique; Tanzania; caesarean section; clinical audit; maternal mortality; task shifting.

Publication types

  • Review

MeSH terms

  • Africa South of the Sahara
  • Cesarean Section / education*
  • Cesarean Section / standards
  • Delivery of Health Care / economics
  • Developing Countries*
  • Emergencies
  • Female
  • Health Personnel / education*
  • Health Personnel / psychology
  • Humans
  • Motivation
  • Obstetric Labor Complications / surgery*
  • Pregnancy
  • Professional Role*
  • Rural Health Services* / economics
  • Rural Health Services* / supply & distribution
  • Workforce