ArticleGlobal health action2024
Successful task shifting: a mixed-methods cross-sectional evaluation of an emergency obstetric care program to increase access to cesarean sections in rural Nepal.
Article in Global health action, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Capacity building through workforce training and community engagement for Surgical, Obstetric, Trauma, and Anaesthesia (SOTA) care: Case studies from South Asia.Dialogues in health · 2026Review
- The effect of deploying non-physician anaesthesia providers on surgical access and capacity across Nepal's primary and secondary government hospitals: a quasi-experimental mixed methods study.BMJ global health · 2026Article
- Monitoring and evaluation strategies for surgical task-shifting and task-sharing interventions: a scoping review.Human resources for health · 2026Article
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10 authors.
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Abstract
backgroundDirect obstetric causes of maternal mortality account for approximately 86% of all global maternal deaths. In Nepal, 12% of all deaths of women of reproductive age are due to preventable obstetric complications in significant part due to the limited distribution and skill level of human resources.
objectivesTo address this, the Advanced Skilled Birth Attendant (ASBA) task-shifting initiative was developed to train medical officers to perform Cesarean sections (CSs) and manage obstetric emergencies in Nepal. Until now, there has been limited study of the program's efficacy.
methodsA survey targeting all 234 ASBA graduates resulted in 93 usable surveys for multivariate regression. Additionally, seven rural government hospitals with ASBA graduates were selected for 13 in-depth interviews and 6 focus group discussions. Results were then triangulated.
resultsImmediately after training, 92.7% of ASBA graduates reported performing CSs, with the majority (65.6%) continuing to perform CSs today. Of the ASBAs not performing CSs, 51.7% could be explained by the lack of a functional operating theater, despite being at hospitals expected to provide CSs. ASBAs were significantly more likely to be performing CSs with a family physician or another ASBA present (
conclusionsThe ASBA program successfully reduces human resource shortages, expands the provision of life-saving Cesarean section, and improves the working conditions in rural hospitals within the LMIC setting.
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