Training non-physician clinicians in Malawi and Tanzania

In-service training among non-physician clinicians in Malawi and Tanzania; implications for managing human resources for health.


An estimated 300,000 women die annually due to pregnancy related causes, with 99% maternal deaths occurring in Low and Middle Income Countries (LMIC). The neonatal death toll follows the same pattern, almost tenfold the maternal deaths, accounting for 43.9% of mortality among children under five (WHO 2015). 

Weak health systems are an underlying factor contributing to the situation in LMICs, including lack of qualified health workforce (GHWA 2013). In recognition of the pivotal role qualified healthcare workers have in reducing maternal and neonatal mortality, recruitment, development, training and retention of the health workforce particularly in LMIC is part of the Sustainable Development Goals (Goal 3(b)) (Osborn 2015).

Through Enhanced Training and Appropriate Technologies for Mothers and Babies in Africa (ETATMBA) program non-physician clinicians (NPCs) from selected districts in Malawi and Tanzania were trained on emergency obstetric care, neonatal care and leadership skills between 2011 and 2013. Understanding the effect of the training on roles performed by non-physician clinicians, their retention at workplace and service delivery is the focus of the thesis.


Qualitative approach is used, based on interviews with NPCs and quarterly mapping of where they work, for the whole cohort of the programme (48 NPCs in Malawi and 70 NPCs in Tanzania). Data collection is currently ongoing using face-to-face, phone and social media communication. Additionally, key information interviews and document review are used to contextualise the NPC perspectives.


Addressing shortage of human resources for health requires multiple approaches including training, retention mechanisms and improving service delivery.