Skip to main content

Table 2 Selected Respondents' Views on Task shifting

From: Policy and programmatic implications of task shifting in Uganda: a case study

(a) Positive Views (b) Negative Views
• Task shifting is real and it is safe when well managed. Even the doctors have come to accept that clinical officers can do many tasks. Let the regulations change to allow easier task shifting with protection of the health professionals (Clinical officer). • Not anybody can be a nurse, we need to look holistically at patient care and the best interests of the patient. Lawyers never let anyone but lawyers take on cases in court, why should we let nursing duties be handled by anyone else? (Assistant commissioner, health services)
• Task shifting works when well planned, with guidelines. Resistance is based on the need to protect professional turf, doctors feel undermined if clinical officers carry out surgical procedures (Respondent from a regulatory council). • We know task shifting is a reality, but we don't have to shout about it as if it's the right thing. We must build capacity for the right people to render the necessary services. The quality of care always suffers when the less qualified take on higher tasks (senior consultant doctor).
• Task shifting is a very good approach; and for psychiatry it is the only solution. It would take very many years to train psychiatrists for the whole country - at present Uganda has only 26 psychiatrists for 30 million people. (Mental health professional) • Task shifting has been adopted by rural facilities as a necessity; but without proper guidelines, it is a ticking time bomb (principal nursing officer).
• Task shifting should not worry any professionals, it is happening every day, and now we have a chance to do it properly. Even if clinical officers are allowed to do more surgery than they are doing now, it will not make the doctors any less important (MoH official) • Considering the issue of circumcision, what happens when all the people have been circumcised? Such a waste of skills! (Hospital manager).
• Task shifting is happening, but should be followed by protection of the nurses when they go beyond their scope through documentation; and when they delegate to lower cadres, there should be proper supervision. (Assistant commissioner, health services) • Task shifting can only be justified when a new structure of the health service is in place, the remuneration of the health workers is much better, and we still see gaps. Otherwise, we are undermining the health system by going for short sighted solutions such as task shifting (senior consultant doctor).
• Resistance to task shifting is all about protecting one's professional turf, that's all there is to it; no one is asking for task shifting to be implemented in a vacuum. So there is need for a change in mindset (FGD participant). • Government should just get the right people for the right jobs. We have the trained people in Uganda, but we are operating with archaic structures that do not take into account the growth in population and the heavy disease burden (Assistant commissioner, health services).
• Task shifting can work, but should be introduced carefully, with clearly identified tasks to be shifted to specific cadres, under specific conditions (Commissioner, health services). • It would be unwise to shift caesarean sections to clinical officers or midwives in Uganda; it is not that it should be only for doctors, but the level of clinical skills that are required to make the decision to operate should not be taken lightly. It would jeopardize patient safety if everyone were allowed to do caesarean sections (senior consultant doctor).
• Task shifting is a good thing that can work with proper regulation and legal protection. The framework already exists, but there is no supporting policy and implementing law as yet (Commissioner, health services). • Task shifting is symptomatic treatment; a mechanism for the poor who are condemned to receiving treatment from sub-standard cadres; the rich are never for task shifted services. Success stories of task shifting in Mozambique and Malawi are exaggerated (Commissioner, health services).
• Task shifting is a good concept but there is no one pushing for it. We all appreciate it because of the shortage of skilled health workers, but it has to be done properly. (senior medical officer)