PREDICTORS OF WILLINGNESS TO TASK SHIFT AMONG FAMILY PLANNING PROVIDERS IN A SOUTH-WESTERN NIGERIAN STATE

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O.O Akinyemi¹, A. Somoye², and V.O Oladoyin³

1. Department of Health Policy and Management, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
2. Association for Reproductive and Family Health, Port-Harcourt, Nigeria
3. Department of Community Medicine, University of Medical Sciences, Ondo, Nigeria

Abstract

Background: Task shifting, the balanced reallocation of tasks usually from a higher cadre to a lower cadre among the health workforce team, has been proposed as a possible solution to the serious shortage of human resource in the health sector is being experienced in many developing countries. This study aimed to assess the views and experiences of nurses on task shifting in family planning services in Ibadan, Southwest Nigeria.

Methods: A descriptive cross-sectional study of 400 nurses with at least a year experience in providing family planning services at purposively selected tetiary, secondary and primary facilities in Ibadan was carried out using an interviewer administered questionnaire. Chi-square test was used to determine association between categorical variables at 5% level of significance.

Results: Mean age of the respondents was 41.1±8.7 years and 62% of the respondents were registered nurses/registered midwives. Although majority (91.5%) of the respondents were aware of the concept of task shifting, only 52.2% were willing to task shift family planning services to lower cadre staff and only 38.5% have actually task shifted family planning services to lower cadre staff. Age, educational status and awareness about task shifting were predictors of willingness to task shift family planning services.

Conclusion: Older registered nurses or registered midwives who were aware of the concept of task shifting were more willing to task shift family planning services. Also, a combination of both awareness and willingness to task shift among married women enhances the practice of task shifting of family planning
services.

Keywords: Task shifting, Task sharing, Policy implementation, Family planning

Introduction

Despite the outcry that the health care workforce is a very useful agent to achieving the Sustainable Development Goals (SDGs),¹ massive shortage of health workers needed to deliver health interventions still exists globally.² The worst hit region in this global health workforce shortfalls is the sub-Saharan African region, which includes Nigeria.^{2, 3} Health care worker shortage in the worst hit region has its attendant impacts and a major one is the slow progress towards universal health coverage.⁴ To mitigate the impacts of health care workers shortfalls, task shifting, defined as the rational redistribution of tasks among health workforce teams, with specific tasks moved from highly qualified health workers to health workers with shorter training and fewer qualifications in order to make efficient use of the available human resources, is recommended.⁵ Task-shifting, formerly referred to as substitution or task-sharing, is not a new concept. It has been in use in many countries as a solution to the human resource crisis in understaffed facilities and this has contributed to increased productivity and efficiency.⁶ With the HIV/AIDS scourge, task shifting has been increasingly promoted at the clinic levels to ensure continued provision of services. In such instances, lower cadre health care workers officially take on additional administrative and clinical responsibilities legally reserved for higher cadre health care workers.^{7, 8} Another sector where task shifting is increasingly gaining popularity due to shortage of health professionals is maternal and reproductive health, including family planning services.⁹

Family planning services include provision of contraception; offering of pregnancy testing and counselling; helping clients who want to conceive, provision of basic infertility services; provision of preconception health services; provision of sexually transmitted diseases screening and treatment; and provision of or referral for other related preventive services such as cervical cancer screening.^{10, 11} Although literature has shown that task shifting some of these family planning services may increase access to and availability of maternal and reproductive health services without compromising performance or patient outcomes and may be cost effective,^{9, 12, 13} maintenance of quality service is still a primary challenge in task shifting.^{14, 15} Often times, supportive supervision for the lower cadre staff assuming these new roles is absent,^14-16 and this may affect the quality of the services that were task shifted.

In Nigeria, the task shifting and task sharing policy document for essential health care services has recommended that some of these family planning services be shifted to or shared with lower cadre health workers such as the Community Health Extension Workers.¹⁷ It is however important to assess the willingness of more specialised health workers to share their tasks with other cadres of health personnel as this may influence their supportive supervision of the lower cadre staff which may in turn influence the quality of services offered by these lower cadre staff. This study was therefore conducted to determine the willingness of family planning providers in a Southwestern Nigerian State to task shift family planning services to lower cadre staff. In this study, we also assessed the practice of task shifting family planning services among family planning providers. Lastly, we assessed the predictors of the willingness and practice of task shifting among the study respondents.