The world’s leading experts in maternal and newborn health say that “task shifting” may be the answer to dealing with the shortage of health-care professionals in low income countries and around the world. They were speaking on 9 October at the XIX International Federation of Gynecology and Obstetrics (FIGO) Congress held at the Cape Town International Conference Centre, Cape Town, South Africa, from 4 to 9 October.
Task shifting, or sharing, consists of a rational redistribution of tasks among health workforce teams. Procedures that are usually done by one professional or technical group would now be transferred to, or shared with, another health professional group that would not normally provide the service. When it comes to pregnancy and childbirth, saving lives can clearly be achieved by working with mid-level health-care providers – non-physician clinicians (NPCs) such as nurses, nurse midwives, nurse auxiliaries and, in some cases, general practitioners, clinical officers, and community health workers. In doing so, countries could scale up the use of NPCs and significantly expand access to emergency obstetric and newborn care.
“It’s time for governments to review the structure of their respective health-care systems, to redefine the scope of practice of their health-care professional teams, and to financially support a collaborative model of maternal newborn care,” said Dr André Lalonde, Executive Vice-President of the Society of Obstetricians and Gynaecologists of Canada.
Maternal death and disability remain the leading cause of healthy life years lost of women of reproductive age in low income countries. To implement a task shifting approach would involve assessing the needs of the specific population, assessing the number of professionals that exist, clearly defining roles and required competencies, and determining what training and evaluation would be required as well as feasible to ensure a sustainable health-care system with continuous support. To be sustainable, task shifting and sharing must be aligned with the broader strengthening of health systems, including human health resource management. Furthermore, career progression for a cadre of health workers with enhanced or specialised skills must be addressed.
Dr Dorothy Shaw, President of FIGO, added, “The shortage of health-care personnel in most developing nations is a tremendous challenge to overcome and constitutes an enormous barrier to achieving Millennium Development Goals 4 and 5, relating to maternal and child health. Getting professional groups to train and share knowledge as well as technical expertise with other health professions is a realistic approach that would go a long way to saving lives by making personnel with needed skills more available to women. We need the right people with the right skills in the right place at the right time to make progress towards universal access to reproductive health.”
Task shifting and sharing is being successfully applied in many fields, including HIV treatment, infectious disease prevention, primary care, family planning and sexual and reproductive health education. The concept of task shifting is attracting the attention of low-resource countries and many developed countries dealing with human resources shortages. The time is now to implement a multidisciplinary collaborative approach to maternal and infant care.