Task shifting in the medical paradigm is the name given to a process of appropriately delegatingÔö¼├íÔö¼├í to less specialized health workers. One of the major constraints to global access to essential health care services is a serious shortage of health workers.Ôö¼├í Globally, at least 57 countries in the world have a crisis shortage of health workers and 36 of those are in Africa. This situation notwithstanding, Africa accounts for 24% of the global burden of disease but only 3% of the global health workforce. In fact, the shortage of Health workers in Africa is estimated at 1 million. The human resource crisis is most acute at the level of specialists including surgeons and anesthesiologists. In relation to maternal health WHO has estimated that countries which haveÔö¼├í fewer than 2.28 doctors, nurses, and midwives per 1000 population areÔö¼├í on average unable to achieve an 80% coverage rate for deliveries by a skilled birth attendant making the reaching of MDG 5 very distant..Ôö¼├í Given the unlikelihood of having significant increases in the number of surgeons working in Africa in the near future, some countries in Africa are training more non-physician clinicians (NPCs) in surgery to be part of the response to the health worker shortage. Realizing the potential of these taskshifting efforts and the gap health worker shortage in East, Central and Southern Africa, the Regional Center for Quality of Health Care was mandated to study the current practices in the task-shifting of the emergency caesarean section practicing countries in order to inform policy in the region.
Objectives: To study and disseminate the policy environment and implementation, NPC training, quality of emergency obstetric surgical care provided by NPCs, NPC practice and support mechanisms in practicing countries.
Setting: Ethiopia, Republic of South Sudan, Zambia, Malawi, Mozambique, and Tanzania.
Methods: National ministries of health were informed of this assessment and provided clearance of assessment. Data was collected by country based medical practitioners employing qualitative study methodologies. Respondents were purposively selected and included NPC tutors, country Ministry of Health officials, NPC regulatory body representatives as well as Practicing NPCs. Data was analyzed by thematic and content analysis at country level and finally aggregated to generate a regional report. Further data validation was conducted by experts from the region.
Result: With the exception of Republic of South Sudan, the five countries were observed to have been practice taskshifting of the caesarean section varying extents and for different durations.Ôö¼├í Health policies in taskshifting practicing countries did not explicitly mention task shifting of the caesarean section. However the national support for NPC training, deployment, remuneration practice signified national approval of taskshifting to NPCs. To this end, strong political support for taskshifting stood out as the most important success factor. All 5 countries had formal training procedures including criteria for entry, curricular and student evaluation.Ôö¼├í The quality of caesarean sections performed by NPCs was reported as satisfactory when compared with the caesarean sections done by other clinicians. A critical gap was found in support mechanisms especially in support supervision, regulation of NPC practice and career progression.
Conclusion: Strong political commitment and leadership, a supportive policy environment, training, in-services support supervision and a predictable career progression are critical ingredients in a successful taskshifting practice for the caesarean section.
Recommendations: Each country should have an explicit policy and guidelines on cesarean section task-shifting to NPCs, strong skills based training curriculum as well as known support and career progression mechanisms.
Authors: Kagurusi Patrick T., MD, HCMTC, MPH1,Ôö¼├í Getachew Tefera, MD, M.Med (Obs/Gyn)1,.
Key words: Taskshifting, cesarean section, Non-physician clinicians
- Regional Center for Quality of Health Care, Makerere University College of Health Science
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