Keywords
HIV; AIDS
Abstract
Background: Tanzania continues to work towards improving her health system in order to provide quality health services amid serious shortages of resources. A serious impediment towards attaining Sustainable Development Goals (SDGs) especially those related to HIV/AIDS, Reproductive and Child Health (RCH), is a shortage of health workers both in terms of numbers and skill-mix. While the problem of shortage is affecting the whole health care delivery system, we focus on the provision of HIV/AIDS and RCH services. The aim of this paper is to gather insights from health managers in Tanzania by exploring their views and experiences about task shifting practices in the delivery of HIV/AIDS and RCH services.
Methods: This was a cross-sectional exploratory study employing qualitative methods of data collection and analysis. It was conducted between June and August in 2012. The study involved interviews with health managers from national level, in nine regions and nine districts of Tanzania. The regions and districts were randomly selected. At the national, regional and district levels, key Informants were selected on the basis of their potential to provide relevant information on task-shifting from practice and their experiences in the fields of HRH, HIV/AIDS and RCH. Analysis of data from in-depth interviews was an ongoing field exercise. Analysis had followed the principles of grounded theory and employed multiple coding.
Results: Task shifting practices are widespread in all health facilities across all cadres of health workers in Tanzania. HIV/AIDS and RCH services are available both in urban and rural areas. However health managers were of the view that due to huge shortage of skilled health workers in rural areas with higher levels of task shifting practices, quality of HIV/AIDS and RCH services in rural areas were considered to be low compared to services provided in urban areas. In addition, it was revealed that task shifting was implemented informally due to absence of policies and guidelines needed to guide the implementation, training and mentorship, monitoring and Evaluation. These guidelines are needed in order to ensure continuity of access and quality of health care services. Finally the study found that in some ways and on top of the acute shortage of health workers, ineffective strategies for attracting and retaining skilled health workers which characterize many rural areas, contribute to increasing the magnitude of task shifting practices in the country.
Conclusion: The absence of policies and guidelines for guiding the implementation of task shifting in the country affect planning and harmonization of important aspects of task shifting such as training, mentorship and supportive supervision. If such policies and guidelines are to be formulated, they can set up a framework to regulate, monitor and evaluate task shifting practices. In the context of professional, regulatory and other barriers to policy change, there is a need to address these challenges before formalizing task shifting practices. However, it is encouraging to see that the Ministry of Health and Social Welfare has committed itself and it is now engaging different stakeholders to ensure that task shifting policy and guidelines are in place by the year 2017.
Citation
Mshana JM, Munga MA, Mushi AK, Mtui TA, Kilale AM, Makamba TY, et al. Task Shifting in the Provision of HIV/AIDS, Reproductive and Child Health (RCH) Services in Tanzania: Exploring the Views and Experiences of Health Managers. SM J Public Health Epidemiol. 2016; 2(3): 1034.