Successes and challenges of non-physician surgeons in the Tigray health system, Ethiopia: a life history method

Task-shifting has emerged as an effective strategy to address the global shortage of healthcare workers. In Ethiopia, a master ’s-level program, Integrated Emergency Surgical Officers(IESO), was introduced to tackle high maternal and neonatal mortality by training BSc-level health professionals to perform both emergency obstetrics and emergency general surgery procedures. This study explored the successes and challenges of IESOs in Tigray, northern Ethiopia, particularly in the recent civil war. Using the life history approach, we interviewed five IESOs working in Tigray. We examined their early life experiences, motivations for joining the health profession and the IESO program, interactions with other healthcare professionals, and their future aspirations. Data were analyzed using thematic analysis with a deductive approach. All participants reported being top students in their early schooling. Past personal experiences with relatives’ health crises motivated them to become health professionals. Their decision to join the IESO program was further fueled by the high maternal and neonatal mortality they witnessed while exercising as BSc holders. While they felt the training prepared them for emergency obstetric procedures, they reported inadequate exposure to general surgical skills. Despite these challenges, participants were confident in managing emergencies within their scope, attributing their competence to both academic training and extensive practical experience. They believed they played a significant role in reducing maternal and neonatal mortality by providing life-saving surgeries closer to rural communities in Tigray. However, they reported day-to-day hurdles, including severe supply shortages, conflicts with other professionals, heavy workloads, limited government support, unclear career pathways, and minimal continuous professional development programs. Although the recent war in Tigray exacerbated these challenges, all participants expressed a commitment to remain in the profession. In Tigray, IESOs perceive that they have contributed towards reduction of maternal and neonatal mortality by delivering essential surgical services in underserved rural areas. Their successes include expanding access to emergency surgery and earning high community acceptance. Persistent challenges include shortages of supplies, professional conflicts, excessive workloads, inadequate systemic support, and limited career advancement opportunities. These issues underscore the need for strengthened support and effective integration of IESOs into Ethiopia’s evolving health system.