Task-shifting: experiences and opinions of health workers in Mozambique and Zambia
Tóm tắt
This paper describes the task-shifting taking place in health centres and district hospitals in Mozambique and Zambia. The objectives of this study were to identify the perceived causes and factors facilitating or impeding task-shifting, and to determine both the positive and negative consequences of task-shifting for the service users, for the services and for health workers. Data collection involved individual and group interviews and focus group discussions with health workers from the civil service. In both the Republic of Mozambique and the Republic of Zambia, health workers have to practice beyond the traditional scope of their professional practice to cope with their daily tasks. They do so to ensure that their patients receive the level of care that they, the health workers, deem due to them, even in the absence of written instructions. The “out of professional scope” activities consume a significant amount of working time. On occasions, health workers are given on-the-job training to assume new roles, but job titles and rewards do not change, and career progression is unheard of. Ancillary staff and nurses are the two cadres assuming a greater diversity of functions as a result of improvised task-shifting. Our observations show that the consequences of staff deficits and poor conditions of work include heavier workloads for those on duty, the closure of some services, the inability to release staff for continuing education, loss of quality, conflicts with patients, risks for patients, unsatisfied staff (with the exception of ancillary staff) and hazards for health workers and managers. Task-shifting is openly acknowledged and widespread, informal and carries risks for patients, staff and management.
Tài liệu tham khảo
Buchan J, Dal-Poz MR: Skills mix in the health care workforce: reviewing the evidence. Bulletin of the World Health Organization. 2002, 80: 575-580.
Grepin KA, Savedoff WD: 10 best resources on health workers in developing countries. Health Policy and Planning. 2009, 24: 479-482. 10.1093/heapol/czp038.
Sidat M, Fernandes B, Mussa A, Ferrinho P: Recursos humanos da saúde em Moçambique: evidências actuais e desafios futuros [Human resources for health in Mozambique: current evidence and future challenges]. Revista Médica de Moçambique. 2010, 10 (suplemento): 1-2.
Tyrrell A, Russo K, Dussault G, Ferrinho P: Costing the scaling-up of human resources for health: lessons from Mozambique and Guinea Bissau. Human Resources for Health. 2010, 8: 14-10.1186/1478-4491-8-14.
Republic of Zambia, Ministry of Health: National health strategic plan (NHSP 2006–2010). 2005, Lusaka: MoH
Republic of Zambia, Ministry of Health: Human resources for health strategic plan 2006 – 2010. 2005, Lusaka: MoH
República de Moçambique, Conselho de Ministros: Plano estratégico sector saúde (PESS) 2001-2005-(2010) [Strategic Health Sector Plan 2001-2005-(2010)]. Versão aprovada em 24 de Abril. 2001, Maputo: RCM
de Moçambique R, da Saúde M: Plano de desenvolvimento de recursos humanos 2008–2015 [Plan for human resource development 2008-2015]. 2008, Departamento de Recursos Humanos: Maputo
Tjoa A, Kapihya M, Libetwa M, Schroder K, Scott C, Lee J, Mc-Carthy E: Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia. Human Resources for Health. 2010, 8 (1): 15-10.1186/1478-4491-8-15.
Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measure to achieve trustworthiness. Nurse Education Today. 2004, 24: 105-112. 10.1016/j.nedt.2003.10.001.
de Moçambique R, da Saúde M: Direcção Nacional de Recursos Humanos, Departamento de Formação: Análise situacional da carreira de enfermagem em Moçambique [Situational analysis of the nursing career in Mozambique]. 2010, Relatório Técnico: Maputo
Wlash A, Ndubani P, Simbaya J, Dicker P, Brugha R: Task sharing in Zambia: HIV service scale-up compounds the human resource crisis. BMC Health Services Research. 2010, 10: 272-10.1186/1472-6963-10-272.
World Health Organization: The World Health Report 2006 - working together for health. 2006, Geneva: WHO
Gish O, Hill KR, Elliot K: Health, manpower and the medical auxiliary. 1971, Intermediate Technology Group Ltd: London
World Health Organization: Taking stock: task-shifting to tackle health worker shortages. 2007, Geneva: WHO
de Moçambique R, da Saúde M: Les soins de santé primaires au Mozambique [Primary health care in Mozambique]. 1977, Republique Populaire du Mozambique/Ministére de la Santé: Maputo
Walt G, Melamed A: Mozambique: towards a people’s health service. 1983, Zed Books, Ltd: London
Kalusa W: Language, medical auxiliaries and the re-interpretation of missionary medicine in colonial Mwinilunga, Zambia, 1922–51. Journal of Eastern African Studies. 2007, 1 (1): 57-58. 10.1080/17531050701218841.
Ferrinho H: O interesse dos aspectos sociais no desenvolvimento rural. Série Economia e Social, n 1 [The relevance of social aspects of rural development. Social and Economic Series, No. 1]. 1964, Moçambique: Instituto do Algodão de Moçambique
Ferrinho H: Fomento algodoeiro e promoção social. Série Economia e Social, n 2 [Development of cotton culture and social advancement. Social and Economic Series, No. 2]. 1965, Moçambique: Instituto do Algodão de Moçambique
Martins H: Porquê Sakrani? Memórias dum médico duma guerrilha esquecida. [Why Sakrani? Memoirs of a doctor in a forgotten guerrilla]. 2001, Maputo: Editorial Terceiro Milénio
Gloyd S, Floriano F, Seunda M, Chadreque MA, Nyangezi JM, Platas A: Impact of traditional birth attendant training in Mozambique: a controlled study. Journal of Midwifery and Women’s Health. 2001, 46 (4): 210-216. 10.1016/S1526-9523(01)00142-8.
Thomas WW: Impact of traditional birth attendant training in Mozambique: a controlled study. Journal of Midwifery and Women’s Health. 2002, 47 (1): 65-66.
Kruk ME, Pereira C, Vaz F, Bergstrom S, Galea S: Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique. BJOG: an international journal of obstetrics and gynaecology. 2007, 114 (10): 1253-1260. 10.1111/j.1471-0528.2007.01443.x.
Ferrinho P, Siziya S, Goma F, Dussault G: The human resource for health situation in Zambia: deficit and maldistribution. Human Resources for Health. 2011, 9: 30-10.1186/1478-4491-9-30.
Ferrinho P, Martins J, Sidat M, Conceição C, Dalpoz MR, Ferrinho F, Tyrell A, Neves C, Dreesch N, Mussa A, Dussault G: A força de trabalho e a política de saúde em Moçambique.[Health workforce and health policy in Mozambique]. Revista Médica de Moçambique. 2010, 10 (suplemento): 3-12.