Suchergebnisse

In Tanzania, the competency-based curriculum for nursing and midwifery was introduced in 2008. Despite the government's efforts to ensure its effective implementation, there has been a public concern on graduate nurses' and midwives' competencies in providing quality nursing care in the country. This concern has influenced people to question the process of the implementation of the same. This study describes experiences of nurse educators in implementing the Competency-Based Education and Training curriculum (CBET) for nursing and midwifery programmes in Tanzania. A descriptive cross-sectional study design using a convergent parallel mixed methods approach was used to describe the experiences of nurse educators in implementing CBET curriculum for nursing and midwifery programme. Of the 264 nurse educators who participated in this study, 240 answered a questionnaire and 24 were interviewed. Chi-square test was used to assess the association between independent and dependent categorical variables. Statistical significance was set at a P value of less than 0.05 and the level of confidence interval was set at 95%. A thematic framework was used to analyse the qualitative data. The implementation fidelity of the CBET curriculum for nursing and midwifery programme was significantly associated with education level (p<0.001) and understanding the concept of CBET approach (p< 0.001). The 97% of the participants used lecture discussion and 53% used simulation in implementing CBET curriculum. Participatory methods of teaching and learning were uncommonly used due to shortage of teaching equipment (30%), time (25%) and lack of skills of some methods (13%). Participants had little understanding and interpretation of the CBET curriculum for effective implementation. For the effective implementation of Nursing and Midwifery programme, there is a need to strengthen nurse educators understanding and interpretation of the CBET curriculum. This can be achieved through mentorship programmes, constant supportive supervision and ...

BACKGROUND: Training of mid-level providers is a task-sharing strategy that has gained popularity in the recent past for addressing the critical shortage of the health workforce. In Tanzania, training of mid-level providers has existed for over five decades; however, concerns exist regarding the quality of mid-level cadres amidst the growing number of medical universities. This study sought to explore the challenges facing the Assistant Medical Officers training for the performance of Caesarean section delivery in Tanzania. METHODS: An exploratory qualitative case study was carried out in four regions to include one rural district in each of the selected regions and two AMO training colleges in Tanzania. A semi-structured interview guide was used to interview 29 key informants from the district hospitals, district management, regional management, AMO training college, and one retired AMO. Also, four focus group discussions were conducted with 35 AMO trainees. RESULTS: Training of AMOs in Tanzania faces many challenges. The challenges include: use of outdated and static curriculum, inadequate tutors (lack of teaching skills and experience of teaching adults), inadequate teaching infrastructure in the existence of many other trainees, including interns, and limited or lack of scholarships and sponsorship for the AMO trainees. CONCLUSIONS: The findings of this study underscore that the challenges facing AMO training for the performance of Caesarean section delivery have the potential to negatively impact the quality of Caesarean sections performed by this cadre. A holistic approach is needed in addressing these challenges. The solutions should focus on reviewing the curriculum, deploying qualified tutors, and improving the competencies of the available tutors through continuing medical education programmes. Furthermore, the government in collaboration with other stakeholders should work together to address the challenges in teaching infrastructure and providing financial support to this cadre that has continued to ...

Abstract Background In Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and CEmOC health facilities and local community members. Methods Semi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at maternity wards at both BEmOC and CEmOC health facilities, and Focus Group Discussions with husbands and community members were conducted between October 2008 and February 2010 at Comprehensive Community Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region. Results Health care users and health providers experienced poor quality caring and working environments in the health facilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse. Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation. Conclusions There was a consensus among women who have suffered serious birth injuries and nurse midwives staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of disempowerment. The bad birth care experiences of women undermine the reputation of the health care system, lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative than home birth. The findings from this study indicate that there is a long way to go.