11 November, 2010, Esther Nakkazi
Task shifting, dumping or sharing for health delivery in Africa debate at ECSA-HC
As Africa grapples with shortages of human resources for health, policy makers are divided on expanding the role of less specialized health workers to deliver services.
Task shifting, dumping or sharing, in any way you would refer to it, could help solve the health work force shortage problem in Africa and improve service delivery.
The World Health Organization (WHO) has already endorsed the programme and produced task-shifting guidelines released last year to steer their implementation.[frax09alpha]
Now, African policy makers and researchers say task shifting can only be a stopgap measure to address the health workforce shortage but African communities deserve the best.
Those supporting the concept say it could be the only solution in the face of brain drain that is cost effective and could readily improve health outcomes.
“We cannot get doctors to go and work in health centres located in remote areas. But clinical officers there can be trained to do basic surgery for common conditions like c-sections, repairing hernias,” said Prof. Francis Omaswa, the executive director for African Centre for Global Health and Social Transformation (ACHEST).
Prof. Omaswa said doing task shifting is not a new concept in Africa but can better be termed as needs-based training, which should be done as a response to a problem.
Already, the concept is in practice by some countries like Uganda that has implemented task shifting as a pragmatic response to the health workforce shortage at an informal level.
This has occurred in the provision of anti-retroviral therapy for HIV/AIDS, integrated management for childhood illnesses by mid-level health workers who are not doctors.
Traditional birth attendants (TBAs) have been trained to handle obstetrics care and village health teams (VHTs) offer community based care.
This has been followed suit with a policy brief to legalize task shifting that optimizes the use of primary health care providers other than doctors.
“The task shifting policy brief is evidence describing the problem and potential solutions,” said Delius Asiimwe, a research scientist with the Supporting Use of Research Evidence for Policy (SURE Project).
The policy brief has an underlying principle that health care should be provided at the lowest level by the least specialized and centralized health worker that can provide appropriate and cost-effective care.
With task shifting, the East and Southern African Health Community (ECSA-HC) meeting of policy makers in Harare, Zimbabwe heard, Africa would make progress to reversing some health statistics.
For instance in Uganda, only 42 percent of mothers deliver with a skilled health provider, only 29 percent of under-five children with fever receive anti-malarials on the same or next day and only 36 percent of children receive basic vaccination by one year of age.
“When I was doing my internship, it was a senior midwife who taught me how to do a C-section. There is no reason that village health teams can not administer deprovera,” said Timothy Musila, a senior health planner with the ministry of Health.
In other wards, mid level practioners properly trained, equipped and supported can perform key clinical tasks at acceptable standards of care.
However, some policy makers and researchers say that task shifting should only be temporary, a stopgap measure as governments think of long term solutions.
“People are running away from their jobs to become mini doctors. We need to address the real problem instead of using task shifting,” said Dr. James Mukabi, the head of International Relations, Kenya.
According to Dr. Mukabi, African governments are just not doing enough to retain doctors at home thus the brain drain. With better working conditions and remuneration, many African doctors would rather stay at home.
Others argue that you cannot get a whole cadre of health workers to take up jobs that they did not train for like pharmacy, surgery and others.
Instead, Africa should change their medical training curriculums to produce more assistant health workers for the various posts.
“You do not want to continue training professionals who leave. Let us concentrate on their assistants, there tendency to move is not as high,” said a doctor from Zimbabwe.
While a doctor from Malawi said task shifting is like delegating people to tasks they were not trained well enough to handle. “We only need bigger health budgets to recruit staff and change policies to build capacity.”
“It is unreasonable not to use non- doctors to change to second line HIV treatment,” said Prof Stephen Kinoti senior research advisor TRAction project.
“We know that it is already happening. Why are we burying our heads in the sand pretending that it is not happening?” said Kinoti who supports task shifting for Africa.
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