Context and setting A health link between Birmingham Children’s Hospital and the paediatric department of Queen Elizabeth’s Central Hospital, the main teaching hospital in Malawi, was established in 2004. The overall purpose of the link is to improve the health of children in Malawi through the education of health care staff. One of the most successful interventions has been a phlebotomy course for patient attendants. Evaluation of the entire link, undertaken in 2008, also provided valuable information about this course and its impact.
Why the idea was necessary Human resources capacity in Queen Elizabeth’s Central Hospital is extremely limited; on most wards two nurses are responsible for the care of approximately 50 patients, as well as for phlebotomy. One or two patient attendants also work on each ward, cleaning and distributing food. The reallocation of tasks from scarce professional staff would represent a valuable rationalisation of resources. It was felt that training the patient attendants in phlebotomy would release trained staff from these duties and improve paediatric care and safe practice when using sharps and dealing with blood samples. It was anticipated that patient attendants would continue to practise and these new skills would subsequently be taught to others as part of a locally delivered training programme.
What was done A venue, 25 students and four facilitators were identified by Queen Elizabeth’s Central Hospital. No patient attendants were taking blood at the hospital before the course. Predictable problems included communication difficulties and increased funding requirements, the procurement and shipping of dark-skinned manikin arms were resolved before departure. In Malawi, 1 day was spent solely with the staff identified as facilitators reviewing the course content and ensuring that staff had the appropriate practical skills to enable them to teach succeeding courses. A week-long phlebotomy course was then delivered by an experienced UK phlebotomy trainer. All theory, including basic anatomy and physiology, venepuncture techniques and communication skills, was delivered from a DVD developed by the National Association of Phlebotomists. The practical components were first practised on training arms and then on out-patients.
Evaluation of results and impact Successful completion of the course required participants to attend the entire course and to make 10 successful venepunctures. All 25 participants successfully completed the course. Medium-term outcomes were also positive. Six months after the training course, 100% of participants were undertaking phlebotomy, on a daily basis (according to self-reported practice). A subsequent phlebotomy course was delivered in December 2008 by local facilitators. During the larger evaluation, information from structured interviews showed that the practice of allocating phlebotomy tasks to patient attendants did indeed release nurses to undertake more skilled tasks. ‘The nurses in all departments really like that we can take bloods; it is easing their burden,’ said one patient attendant. The matron commented: ‘It really does have some impact.’ The patient attendants also felt they had an enhanced job role, which in turn improved their enthusiasm for learning new skills. The head of the paediatric department remarked: ‘This [taking blood] is more than just technical – it’s a mind change.’ Small teaching interventions can have a significant impact on health care staff in resource-poor countries. This intervention, carried out as part of a wider health link, has shown an immediate and longer-term positive impact for the health care staff involved and, by inference, for the patients they are caring for.