Major surgery delegation to mid-level health practitioners in Mozambique: health professionals' perceptions

Amelia Cumbi¹ , Caetano Pereira²^,3 , Raimundo Malalane³ , Fernando Vaz³ , Colin McCord⁴ , Alberta Bacci⁵ and Staffan Bergström²^,4

¹Independent public heath consultant, Maputo, Mozambique

²Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden

³Higher Institute of Health Sciences, Maputo, Mozambique

⁴School of Public Health, Columbia University, New York, USA

⁵World Health Organization, Copenhagen, Denmark

author email corresponding author email

Human Resources for Health 2007, 5:27doi:10.1186/1478-4491-5-27


Published:	6 December 2007

Abstract

Background

This study examines the opinions of health professionals about the capacity and performance of the 'técnico de cirurgia', a surgically trained assistant medical officer in the Mozambican health system. Particular attention is paid to the views of medical doctors and maternal and child health nurses.

Methods

The results are derived from a qualitative study using both semi-structured interviews and group discussions. Health professionals (n = 71) were interviewed at both facility and system level. Eight group discussion sessions of about two hours each were run in eight rural hospitals with a total of 48 participants. Medical doctors and district officers were excluded from group discussion sessions due to their hierarchical position which could have prevented other workers from expressing opinions freely.

Results

Health workers at all levels voiced satisfaction with the work of the "técnicos de cirurgia". They stressed the life-saving skills of these cadres, the advantages resulting from a reduction in the need for patient referrals and the considerable cost reduction for patients and their families. Important problems in the professional status and remuneration of "técnicos de cirurgia" were identified.

Conclusion

This study, the first one to scrutinize the judgements and attitudes of health workers towards the "técnico de cirurgia", showed that, despite some shortcomings, this cadre is highly appreciated and that the health delivery system does not recognize and motivate them enough. The findings of this study can be used to direct efforts to improve motivation of health workers in general and of técnicos de cirurgia in particular.