Health Affairs

Health Affairs, 28, no. 5 (2009): w876-w885 (Published online 6 August 2009) doi: 10.1377/hlthaff.28.5.w876 © 2009 by Project HOPE	New Online   Getting Health Reform Done   After the State of the Union   Incremental Reform   E-Health in Developing World   Most-Read Articles in 2009

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The Quality Of Emergency Obstetrical Surgery By Assistant Medical Officers In Tanzanian District Hospitals

Colin McCord, Godfrey Mbaruku, Caetano Pereira, Calist Nzabuhakwa and Staffan Bergstrom

Five countries in sub-Saharan Africa use nonphysicians to perform major emergency obstetrical surgery. In Tanzania, assistant medical officers provide most of this surgery outside of major cities. Questions about the quality of surgery by nonphysicians have kept most African countries from following this example. We reviewed the records of all patients admitted for complicated deliveries to fourteen district hospitals during four months. Among 1,134 complicated deliveries and 1,072 major obstetrical operations, there were no significant differences between assistant medical officers and medical officers in outcomes, risk indicators, or quality. There were significant differences between mission and government hospitals.

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