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. 2018 May 2;16(1):20.
doi: 10.1186/s12960-018-0282-z.

Task shifting in health service delivery from a decision and policy makers' perspective: a case of Uganda

Sebastian Olikira Baine  1 , Arabat Kasangaki  2 , Euzobia Margaret Mugisha Baine  3
Affiliations

Task shifting in health service delivery from a decision and policy makers' perspective: a case of Uganda

Sebastian Olikira Baine et al. Hum Resour Health. .

Abstract

Background: Documented evidence shows that task shifting has been practiced in Uganda to bridge the gaps in the health workers' numbers since 1918. The objectives of this study were to provide a synthesis of the available evidence on task shifting in Uganda; to establish levels of understanding, perceptions on task shifting and acceptability from the decision and policy makers' perspective; and to provide recommendations on the implications of task shifting for the health of the population in Ugandan and human resource management policy.

Methods: This was a qualitative study. Data collection involved review of published and unpublished literature, key informant interviews and group discussion for stakeholders in policy and decision making positions. Data was analyzed by thematic content analysis (ethical clearance number: SS 2444).

Results: Task shifting was implemented with minimal compliance to the WHO recommendations and guidelines. Uganda does not have a national policy and guidelines on task shifting. Task shifting was unacceptable to majority of policy and decision makers mainly because less-skilled health workers were perceived to be incompetent due to cases of failed minor surgery, inappropriate medicine use, overwork, and inadequate support supervision.

Conclusions: Task shifting has been implemented in Uganda for a long time without policy guidance and regulation. Policy makers were not in support of task shifting because it was perceived to put patients at risk of drug abuse, development of drug resistance, and surgical complications. Evidence showed the presence of unemployed higher-skilled health workers in Uganda. They could not be absorbed into public service because of the low wage bill and lack of political commitment to do so. Less-skilled health workers were remarked to be incompetent and already overworked; yet, the support supervision and continuous medical education systems were not well resourced and effective. Hiring the existing unemployed higher-skilled health workers, fully implementing the human resource motivation and retention strategy, and enforcing the bonding policy for Government-sponsored graduates were recommended.

Keywords: Competences; Higher skilled health workers; Support supervision; Task shifting.

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Conflict of interest statement

Ethics approval and consent to participate

The research protocol was submitted for consideration, guidance, and approval to the Uganda National Council of Science and Technology (reference number SS 2444). It takes into consideration the laws and regulations governing research in Uganda and approves and monitors ongoing studies regularly. It is independent of the researchers, sponsors, and any other undue influence.

Each potential subject was adequately informed of the aims, methods, sources of funding, institutional affiliation of the researchers, and the anticipated benefits and potential risks of the study. There was no conflict of interest in this research study. Subjects were assured that there would be no harm as a consequence of participation in this research study or predictable risks and burdens to the individuals and communities in comparison with foreseeable benefits to them and to other individuals or communities.

The potential subjects were informed of their right to refuse to participate in the study or to withdraw consent to participate at any time without reprisal. Precautions were taken to protect the privacy of the subjects, confidentiality of personal information, and to minimize the impact of the study on their physical, mental, and social integrity. Subjects gave informed consent to participate in this research study without duress. They were also informed of their freedom to access the results of this study and to use evidence generated by this study as they wished.

Consent for publication

We, the authors of this paper, agree and consent that it be published by BMC Human resources.

Competing interests

The authors declare that they have no competing interests.

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References

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