Feasibility of task-sharing with community health workers for the identification, emergency management and referral of women with pre-eclampsia, in Mozambique
Background: Maternal mortality is an important public health problem in low-income countries. Delays in reaching
health facilities and insufficient health care professionals call for innovative community-level solutions. There is limited
evidence on the role of community health workers in the management of pregnancy complications. This study
aimed to describe the feasibility of task-sharing the initial screening and initiation of obstetric emergency care for
pre-eclampsia/eclampsia from the primary healthcare providers to community health workers in Mozambique and
document healthcare facility preparedness to respond to referrals.
Method: The study took place in Maputo and Gaza Provinces in southern Mozambique and aimed to inform the
Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomized controlled trial. This was a mixed-methods
study. The quantitative data was collected through self-administered questionnaires completed by community
health workers and a health facility survey; this data was analysed using Stata v13. The qualitative data was collected
through focus group discussions and in-depth interviews with various community groups, health care providers, and
policymakers. All discussions were audio-recorded and transcribed verbatim prior to thematic analysis using QSR
NVivo 10. Data collection was complemented by reviewing existing documents regarding maternal health and community
health worker policies, guidelines, reports and manuals.
Results: Community health workers in Mozambique were trained to identify the basic danger signs of pregnancy;
however, they have not been trained to manage obstetric emergencies. Furthermore, barriers at health facilities were
identified, including lack of equipment, shortage of supervisors, and irregular drug availability. All primary and the
majority of secondary-level facilities (57%) do not provide blood transfusions or have surgical capacity, and thus such
cases must be referred to the tertiary-level. Although most healthcare facilities (96%) had access to an ambulance for
referrals, no transport was available from the community to the healthcare facility.Medicine, Faculty ofNon UBCObstetrics and Gynaecology, Department ofReviewedFacultyResearche
