Task Shifting Strategy In Addressing Reproductive Health In Kenya
Margaret Chan, director of WHO, defined task shifting as rational distribution of tasks among health workers team where specific tasks are removed from highly qualified health worker to health worker with shorter training and few qualifications. It was a method of strengthening and expanding health workforce to rapidly increase access HIV and other services. Since then, it has been a low-cost solution in tackling gaps in health services. However, it should be implemented alongside other strategies.
Task shifting has been a strategy in addressing reproductive health in Kenya. It was adopted to address physicians’ shortage by expanding tasks of associate clinicians to include provision of caesarian section. The strategy assumes that there is underutilization of capacity of clinicians, it is desirable and possible to change priorities of less specialized clinicians to include tasks from doctors and number of specialized health professionals can be increased to accommodate increased responsibilities cost-effectively. This has shown clinical efficacy and economic value of tasking to clinical officers. Kenya community registered nurses and enrolled nurses have also been able to increase coverage of family planning methods in rural Kenya by offering implants. This has been successful because tasks have determined whether they are prohibited, included in job description authorized by employer, supported by policy, guidelines & protocols and covered by cadre's scope of practice endorsed by the regulatory body. Clinician to perform the task is assessed for competency and experience to perform Caesarian section safely. Resources and supervision are ensured to be available and referral structures are in place in case of emergency.
The establishment of national task sharing policy in Kenya have boosted task shifting.Task shifting, however, has been viewed as a quick fix intended for poor and a threat to quality care and likely to compromise the weak health system. This has seen a rise of professional protectionism with doctors feeling that their schooling time is not just that anyone can do a doctor's job while nurses feel their jobs have been invaded by nurse aids and community health workers. Together with poor remuneration and working conditions, the professionals view task shifting as a ploy of government to avoid paying the right people to do the right jobs.
Although the regulatory environment is permissive, the cadre has no legal protection for additional tasks if anything goes wrong and the perceived focus on HIV/AIDS make people view task shifting as another initiative to weaken health systems including shift focus of the resources.
With standardized training, assessment & certification and supportive supervision to the tasked individuals, task shifting can be more effective in resolving human resource challenge. For it to be effective, messages should be simplified, the treatment should be unpacked, treatment delivered where people are, use affordable & available human resource and reallocate the specialist to train and supervise the task being shifted. This will democratize medical knowledge and medical power hence empowering ordinary people to be more effective in service provision hence revolutionizing health for all campaign.
