By Irene Nabusoba

DIANA Kateeme, a midwife, is what we would call a modern Florence Nightingale. Her heart is full of compassion and her hands are always working round the clock to save lives.

This morning, she is standing-in for her boss, a medical doctor to man one of the heath centre IVs in Mbale because he is attending a conference in Kampala.

“My role is to assist in child birth but with the understaffing, I do anything; from taking a malaria slide in the lab to providing post-abortion care, conducting a blood transfusion and prescribing medicine. I have mastered everything here,” says Kateeme. “The only thing I have not done is a c-section but since I always help the doctor in the theatre, I can do it.”

Task shifting
Dr Nathan Kenya Mugisha, the director of health services (community and clinical services), says task shifting is a rational redistribution of tasks among health workforce teams.

“For instance, caesarean births were a preserve of doctors but in some countries, clinical officers have conducted these procedures successfully,” Mugisha explains.

He says in Uganda, medical abortion services were a preserve of doctors. However, midwives today are the ones managing post-abortion care, manual vacuum aspiration and dilation and curette. Similarly, teams with basic skills and no formal clinical training are doing the work of professionals like dispensing antimalarial drugs, offering HIV counselling and family planning services like injectaplan and immunisation.

Insufficient funds
Meanwhile, the employed doctors and nurses are not satisfied with their remunerations. No wonder many seek greener pastures abroad.

Some people wonder whether governments are failing to supervise and monitor the provision of health services hence shifting the weight off irresponsible professionals to lower poorly paid cadres in the name of task shifting.

But Mugisha attributes the problem to financial constraints. “We have many health workers but we cannot absorb them. We cannot employ more professionals with no remuneration budgets. That is where task shifting comes in handy,” he explains.

At a meeting in Maputo, African heads of state agreed to allocate 15% of their national budgets to health to cater for staff shortage and quality delivery of healthcare.

However, Uganda has stagnated at 9% for the last three years.

Solution to shortage
Mugisha says there is inadequate distribution of personnel between urban and rural settings with over 80% and 60% of the nurses and midwives found in hospitals which mostly serve urban populations.

He says a health centre IV offers preventive, promotive, out-patient curative and maternity, in-patient health services and emergency surgery, blood transfusion and laboratory services but may be constrained by staff shortage. The services are provided by one doctor who may not always be available and four midwives who are inadequate. Sometimes the positions are not even filled.

“The workforce is constrained by unequal distribution and inappropriate skills and the answer lies in task shifting,” Mugisha says.

He adds that the policy makers understand this concept which is doing well. “We are encouraging all-rounders although renumeration can be a big challenge.”

Mugisha says while high attrition has been noted with village health teams, Uganda has high retention levels.

“We give motivational items like bicycles and t-shirts to these community health teams. That makes them appreciate their work,” he explains.

Mugisha notes that the challenge is there is no written policy yet.

How system can be improved
Dr. Dan Wendo from Futures Group suggested at the conference: “Consider staffing, types of skills and specialisation, assess human resource capacity, particularly across the country and specialised groups,” he says. “Also address professionalism with skill mix and ensure regulatory mechanisms and mentoring. We can ensure quality by distributing excess specialised professionals to other areas.”

Mugisha advises that task shifting should be seen in the context of emergency and crisis situations like environmental disasters or chronic epidemics like HIV/AIDS.

“In short, task shifting has been handy in managing infection control like prevention of mother-to-child AIDS transmission, cholera, TB, expanding cancer treatment and promoting nutrition,” he says.