However, there also is evidence of poor quality of services rendered by MLPs: a cost-effectiveness study of Caesarean sections in Burkina Faso revealed that clinical officers were associated with a higher maternal and newborn case fatality rate as compared to general practitioners and obstetricians, pointing to the need for improved training and strengthened supervision.29 Similarly, a study from Uganda found that performance problems were often linked to inadequate training and/ or support and supervision, as well as lack of guidelines.
Sin embargo, también existe evidencia de una mala calidad de los servicios prestados por los TSNI: un estudio de costo-efectividad de cesáreas en Burkina Faso reveló que las atenciones realizadas por trabajadores de nivel intermedio fueron asociadas con una mayor tasa de letalidad materna y neonatal en comparación con los médicos generales y obstetras, señalando la necesidad de mejorar la formación y reforzar la supervisión 29.