Abstract:
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 The challenges include: use of outdated and static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 be the backbone of primary healthcare in Tanzania. Long-term solutions should consider deploying
medical officers at the primary facilities and phasing out the performance of Caesarean section by AMOs.
