Trial reportHuman resources for health2019
The contribution of non-physician clinicians to the provision of surgery in rural Zambia-a randomised controlled trial.
Trial report in Human resources for health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 4 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Pooled it
- Surgical site infections after caesarean section across sub-Sahara Africa: a scoping review of prevalence and associated factors.Frontiers in global women's health · 2025Pooled it
- Task Shifting and Task Sharing to Strengthen the Surgical Workforce in Sub-Saharan Africa: A Systematic Review of the Existing Literature.World journal of surgery · 2023Pooled it
- Assessing the impact of anaesthetic and surgical task-shifting globally: a systematic literature review.Health policy and planning · 2023Pooled it
- Monitoring and evaluation strategies for surgical task-shifting and task-sharing interventions: a scoping review.Human resources for health · 2026Article
- Expanding Access to Orthopedic Trauma Care: Evaluation of a Task-Sharing Model With a Remote Quality Assessment Tool for Open Tibia Shaft Fractures in Malawi.World journal of surgery · 2026Article
- Surgical task-sharing in Sierra Leone: barriers and enablers from provider and facilitator perspectives.BMJ global health · 2025Article
- Successful task shifting: a mixed-methods cross-sectional evaluation of an emergency obstetric care program to increase access to cesarean sections in rural Nepal.Global health action · 2024Article
- Article
- Professional care workforce: a rapid review of evidence supporting methods of recruitment, retention, safety, and education.Human resources for health · 2023Review
- Using participatory action research to empower district hospital staff to deliver quality-assured essential surgery to rural populations in Malawi, Zambia, and Tanzania.Frontiers in public health · 2023Article
- Critical shortage of capacity to deliver safe paediatric surgery in sub-Saharan Africa: evidence from 67 hospitals in Malawi, Zambia, and Tanzania.Frontiers in pediatrics · 2023Article
- Article
- Access to quality surgical care in Nigeria: A narrative review of the challenges, and the way forward.Surgery in practice and science · 2022Review
- Surgical service monitoring and quality control systems at district hospitals in Malawi, Tanzania and Zambia: a mixed-methods study.BMJ quality & safety · 2021Article
- Policy options for surgical mentoring: Lessons from Zambia based on stakeholder consultation and systems science.PloS one · 2021Article
- Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa-a scoping review.Human resources for health · 2020Article
- Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia.Human resources for health · 2020Article
- Developing the health workforce for universal health coverage.Bulletin of the World Health Organization · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
Abstract
backgroundThe global shortage of surgeons disproportionately impacts low- and middle-income countries. To mitigate this, Zambia introduced a 'task-shifting' solution and started to train non-physician clinicians (NPCs) called medical licentiates (ML) to perform surgery. The aim of this randomised controlled trial was to assess their contribution to the delivery of surgical care in rural hospitals in Zambia.
methodsSixteen hospitals were randomly assigned to intervention and control arms of the study. Nine MLs were deployed to eight intervention sites. Crude numbers of selected major surgical procedures between intervention and control sites were compared before and after the intervention. Volume and outcomes of surgery were compared within intervention hospitals, between NPCs and surgically active medical doctors (MDs).
resultsThere was a significant increase in the numbers of caesarean sections (CS) in the intervention hospitals (+ 15.2%) and a drop by almost half in the control group (- 47%) (P = 0.015), between the two time periods. There were marginal shifts in the numbers of index procedures: a small drop in the intervention group (- 4.9%) and slight increase in the control arm (+ 4.8%) (P = 0.505). In all pairs, MLs had higher mean number of CS and other major surgical cases done in the intervention period compared with MDs. There was no significant difference in postoperative wound infection rates for CS (P = 0.884) and other major surgical cases (P = 0.33) at intervention hospitals between MLs and MDs.
conclusionThis study provided evidence that the ML training programme in Zambia is an effective and safe way to bridge the gap in rural hospitals between the demand and the limited availability of surgically trained workforce in the country. Such evidence is greatly needed as more developing countries are developing national surgical plans.
trial registrationISRCTN66099597 Registered: 07/01/2014.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.