Task Shifting in Family Planning Explored in International Conference in Dakar
In 2006, the World Health Organization (WHO) made the world aware of the chronic shortage of well-trained health workers, particularly in sub-Saharan Africa, and task shifting was adopted as one of the tools for addressing this shortage and improving access to health care, especially HIV services.
The WHO defines task shifting as “the rational re-distribution of tasks among health workforce teams. Specific tasks are moved, where appropriate, from highly qualified health workers to health workers who have fewer qualifications in order to make more efficient use of the available HRH [human resources for health].”
AMREF strongly supports the role task shifting can play in helping fill the gaps left by the health workers shortage, and has just released this Position Statement on Task Shifting.
In Dakar, Senegal this week, the second International Conference on Family Planning — the largest gathering of family planning practitioners, advocates and supporters in the world — is also looking at task shifting in the context of family planning (FP) and reproductive health: We found five of the 121 abstract-driven sessions addressed task-sharing. Much of what we found supports the positions AMREF lays out in this statement, namely our positions that:
- Task shifting in Africa is a reality in health care service delivery.
- Task shifting presents a viable solution for improving health care coverage by making more efficient use of the human resources already available.
- A systematic approach to ensure harmonized, standardized and competency-based training is needed.
- Successful task shifting requires training and changes in laws and policies to accommodate workers with improved skills.
- Appropriate supervision and support in task shifting is crucial for quality assurance.
- Task shifting needs to be flexible to the opportunities and constraints on the ground.
- Clear regulation is needed to protect the public by providing frameworks within which the scope of practice, standards of education and codes of conduct for regulated professions is set out.
- Performance-based incentives or other methods by which to retain and enhance the performance of health workers with new or increased responsibilities are needed.
Several Dakar conference abstracts presented on-the-ground experience with different aspects of task shifting. The presentation entitled “Task Shifting for Family Planning” shared the following examples:
- ETHIOPIA: Pathfinder International supported the training of 1,000 health extension worker (HEW) supervisors and clinical providers in long-term FP methods, especially intrauterine devices (IUDs). Later, these supervisors and providers trained 2,500 HEWs. A total of 40,000 insertions were performed during the first year after training by trained HEWs. The study showed that task shifting can rapidly increase service coverage, quality and client satisfaction.
- RWANDA: An IntraHealth study showed that a project to provide nurses with training in long-term methods, emphasizing IUDs, greatly increased adoption of IUDs in the four districts studied. Task shifting with nurses improved women’s access to FP, helped decrease unmet demand and may have freed up physicians to dedicate more time to urgent cases.
- KENYA: A FHI 360 and Jhpiego pilot project trained community-based distributors (CBDs) in the use of the DMPA injectable who, in turn, reached 1,245 women with a range of FP services. More than two-thirds of those women either initiated or continued using DMPA through the CBDs. The pilot produced evidence that confirms the safety, acceptability, feasibility and effectiveness of the CBDs.
- NIGERIA: This Pathfinder International project used female Muslim and Christian religious leaders to reach women in their homes and provide them with information about FP in a religious context. Prior to the intervention, only 9% of the 147 women reached used a modern FP method. After the intervention, 73% of the women reported current use of a modern method. Data from this project suggests that “effective programs reach women with firsthand messages that directly challenge the religious and cultural dogmas within their homes.”
In a separate presentation entitled “Shifting tasks and facilities: Making long-term family planning methods more accessible in Senegal,” an IntraHealth pilot project trained 190 health post nurses on long-acting methods. These trainings contributed significantly to increased FP service delivery in 243 health posts. In Dakar, FP use increased from 6.6% to 13.7%. In other regions, it increased from 4.4% to 7.7% on average. This pilot showed that nurses, when trained in a range of FP methods, can help increase contraceptive prevalence.
AMREF has been actively involved in capacity-building in South Sudan since 1972 and began training clinical officers during the war (a clinical officer is a cadre between physician and nurse that is trained for half the time and at one-fifth the cost and can carry out 70% of the work a physician does). This work offers a good example of task shifting.
AMREF did a study of the graduates of the Maridi National Training Institute, which trains 80% of all clinical officers in South Sudan, to determine the proportion of graduates still working in South Sudan and what they were doing. The study showed that 99% of the 213 graduates studied were still working in the country and that these officers have been accepted and acclaimed as “the Doctors of South Sudan.”
After the peace agreement of 2005, AMREF developed standardized curricula for the training of community midwives, clinical officers and community health workers and also worked with the Government of South Sudan to integrate task shifting into the standardization of all training curricula materials for clinical officers, as described in AMREF’s paper “Shifting tasks to save lives: The example of AMREF-trained clinical officers in Southern Sudan.”
AMREFʼs technical support to the Government of South Sudan played a key role in the creation of an enabling environment through good government policies on human resources, including task shifting. For task shifting to be successful, policies that support it must be encouraged in order to make essential health services more widely available, particularly in post-conflict settings like South Sudan.
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