Task-shifting: experiences and opinions of health workers in Mozambique and Zambia

Ferrinho, Paulo; Sidat, Mohsin; Goma, Fastone; Dussault, Gilles

doi:10.1186/1478-4491-10-34

Cited by 39 publications

(41 citation statements)

References 10 publications

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“…Much more emphasis is needed on measuring the processes of care ‒ the content and nature of clinical interactions ‒ and the intangible elements of care underlying those interactions ‒ such as health-sector organization, facility management and staff training and motivation. This is especially timely as it relates to ongoing debates on task-shifting of health care from physicians to non-physician health workers 36 . Ultimately, we need evidence linking quality of care to health outcomes, and this is why the benchmarking of quality of care in the specific context of low- and middle-income countries is necessary.…”

Section: Current Statusmentioning

confidence: 99%

Quality of care: measuring a neglected driver of improved health

Akachi

Kruk

2016

Bull. World Health Organ.

124

110

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The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact.

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Section: Current Statusmentioning

confidence: 99%

Quality of care: measuring a neglected driver of improved health

Akachi

Kruk

2016

Bull. World Health Organ.

124

110

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“…Both absolute and relative shortages persist despite the application of innovative approaches to deal with human resources for health (HRH) issues [7]. Attrition rates among health workers are high as a result of migration to other countries and death due to HIV/AIDS, resulting in low staff motivation and poor morale [8-10].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of recruitment and retention strategies for health workers in rural Zambia

et al. 2014

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BackgroundIn response to Zambia’s critical human resources for health challenges, a number of strategies have been implemented to recruit and retain health workers in rural and remote areas. Prior to this study, the effectiveness of these strategies had not been investigated. The purpose of this study was to determine the impacts of the various health worker retention strategies on health workers in two rural districts of Zambia.MethodsUsing a modified outcome mapping approach, cross-sectional qualitative and quantitative data were collected from health workers and other stakeholders through focus group discussions and individual interview questionnaires and were supplemented by administrative data. Key themes emerging from qualitative data were identified from transcripts using thematic analysis. Quantitative data were analyzed descriptively as well as by regression modelling. In the latter, the degree to which variation in health workers’ self-reported job satisfaction, likelihood of leaving, and frequency of considering leaving, were modelled as functions of participation in each of several retention strategies while controlling for age, gender, profession, and district.ResultsNineteen health worker recruitment and retention strategies were identified and 45 health care workers interviewed in the two districts; participation in each strategy varied from 0% to 80% of study participants. Although a salary top-up for health workers in rural areas was identified as the most effective incentive, almost none of the recruitment and retention strategies were significant predictors of health workers’ job satisfaction, likelihood of leaving, or frequency of considering leaving, which were in large part explained by individual characteristics such as age, gender, and profession. These quantitative findings were consistent with the qualitative data, which indicated that existing strategies fail to address major problems identified by health workers in these districts, such as poor living and working conditions.ConclusionsAlthough somewhat limited by a small sample size and the cross-sectional nature of the primary data available, the results nonetheless show that the many health worker recruitment and retention strategies implemented in rural Zambia appear to have little or no impact on keeping health workers in rural areas, and highlight key issues for future recruitment and retention efforts.

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“…They take over some of the tasks of doctors so that their time is freed up to perform higher-level functions. Some of these tasks are currently being performed by nursing staff though they are outside of their scope of practice, a form of task-shifting that is common in resource-poor settings (12). By allowing other cadres to focus on their own roles and fulfil them better, and strengthening a level of hospital care that suffers severe staff shortages in South Africa, clinical associates will provide better access to care for marginalised communities and reduce the need for referral.…”

Section: Resultsmentioning

confidence: 99%

“…In the meantime, clinical associates have been stopped from prescribing by the Pharmacy Council, at least until new regulations are promulgated, while recently qualified clinical associates are beginning to challenge their salary scales, given the extensive amount of work they are taking over from doctors. It is the international experience that it is difficult to clarify and protect the boundaries between the scopes of practice of different health professional categories, especially in settings that are hugely under-resourced, as tasks have to be shared by whoever is on duty (12). It is also likely in South Africa that clinical associates in some hospitals will be expected to perform their duties without the required supervision as doctors are not always available, as has been the experience with newly graduated doctors working through their community service commitments (16).…”

Section: Resultsmentioning

confidence: 99%

Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates

Doherty

Conco

Couper

et al. 2013

Global Health Action

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BackgroundMid-level medical workers play an important role in health systems and hold great potential for addressing the human resource shortage, especially in low- and middle-income countries. South Africa began the production of its first mid-level medical workers – known as clinical associates – in small numbers in 2008.ObjectiveWe describe the way in which scopes of practice and course design were negotiated and assess progress during the early years. We derive lessons for other countries wishing to introduce new types of mid-level worker.MethodsWe conducted a rapid assessment in 2010 consisting of a review of 19 documents and 11 semi-structured interviews with a variety of stakeholders. A thematic analysis was performed.ResultsCentral to the success of the clinical associate training programme was a clear definition and understanding of the interests of various stakeholders. Stakeholder sensitivities were taken into account in the conceptualisation of the role and scope of practice of the clinical associate. This was achieved by dealing with quality of care concerns through service-based training and doctor supervision, and using a national curriculum framework to set uniform standards.ConclusionsThis new mid-level medical worker can contribute to the quality of district hospital care and address human resource shortages. However, a number of significant challenges lie ahead. To sustain and expand on early achievements, clinical associates must be produced in greater numbers and the required funding, training capacity, public sector posts, and supervision must be made available. Retaining the new cadre will depend on the public system becoming an employer of choice. Nonetheless, the South African experience yields positive lessons that could be of use to other countries contemplating similar initiatives.

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Task-shifting: experiences and opinions of health workers in Mozambique and Zambia

Cited by 39 publications

References 10 publications

Quality of care: measuring a neglected driver of improved health

Quality of care: measuring a neglected driver of improved health

Evaluation of recruitment and retention strategies for health workers in rural Zambia

Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates

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