Performance and self-perceived competencies of enrolled nurse/midwives: a mixed methods study from rural Tanzania

BACKGROUND: Tanzania is experiencing a severe shortage of human resources for health, which poses a serious threat to the quality of health care services particularly in rural areas. Task shifting has been considered a way to address this problem. However, since a large percentage of health care providers in rural setting is comprised of Enrolled Nurse/Midwives (ENMs), most of the health care tasks are shifted to them. This article analyzes the performance and self-perceived competencies of ENMs at the dispensary level; the lowest health facility in Tanzania. Performance refers to routine duties performed by ENMs, and self-perceived competence means self-perceived proficiency in performing nursing/midwifery and medical duties. METHODS: This was a mixed methods study conducted in rural Tanzania. A purposeful sample of twelve (12) informants (six ENMs; two Community Leaders [CLs] and four Dispensary In-charges [DIs]) was recruited for semi-structured interviews. The interviews were supplemented with quantitative data from 59 ENMs. Both thematic and descriptive analysis approaches were used. RESULTS: Three themes emerged: (1) ‘Approval of the performances of ENMs in meeting community health needs’ underscores important services the community members got from ENMs at dispensaries. (2) ‘Experienced difficulties of meeting community health needs’ indicate the problems ENMs encountered while providing services to the community. In striving to serve a large number of demanding clients without adequate medical equipment and supplies, sometimes the ENMs ended up with prescription errors (3) ‘Appreciating the performances and competencies of ENMs’ shows the acknowledgement of community members towards ENMs’ performance and competencies within and beyond their scope of practice. The community members as well as ENMs and their supervisors knew that ENMs must sometimes provide care that is outside their scope of training and competency. Overall, the performance among ENMs above 38 years of age (P < 0.05) and participants of professional development courses (P < 0.01) was high. CONCLUSIONS: The results highlight performance and self-perceived competencies of ENMs in struggling to meet community health needs. Additionally, these results highlight the health care system shortfalls in supporting and developing an adequate number of qualified health care professionals so that health care needs of all citizens, including those in rural areas, are met.