Abstract
BackgroundMost sub-Saharan African countries have too few reproductive health (RH) specialists, resulting in high RH-related mortality and morbidity. In Kenya, task sharing in RH began in 2002, with the training of clinical officer(s)–reproductive health (CORH). Little is known about them and the extent of their role in the health system.MethodsIn 2016, we conducted a retrospective, quantitative two-stage study in Kenya to evaluate the use of CORH and 28 of their curriculum-derived RH competencies, to determine their contribution to expanded access to RH care. CORH were surveyed, using structured questionnaires and telephone interviews. Data on the frequency with which CORH used specified competencies were collected from health records in selected facilities.ResultsForty-nine of all 104 CORH participated in the survey (47%). Forty-eight (98%) had worked in the clinical area, and 79% were still engaging in clinical work. All 48 worked in emergency obstetrics, emergency gynaecology, and nonemergency RH, and 38 (79%) filled clinical leadership positions. Vasectomy was least performed, by only 9 (18%) CORH. All other competencies were applied by at least half of the CORH, and 22 competencies by more than three quarters. Forty-one (84%) CORH performed caesarean section (CS). Teaching and management were other common responsibilities.Data were collected from 12 facilities and analysed for 11. They generally confirmed the initial survey findings: CORH worked as obstetrics and gynaecology consultants and used most of their competencies. Analysis was based on 118 months of theatre records. CORH made significant contributions to their facility’s capacity to perform RH surgery: most respondents performed at least 25% of these surgeries. They performed an average of six CS per month and more than 25% of perineal tear repairs (33%), uterus repairs (33%), manual placenta removals (26%), bilateral tubal ligations (39%), and cervical cancer staging (27%). Some experienced CORH conducted procedures beyond their training.ConclusionsCORH expand access to emergency RH care. Their contributions span all areas of obstetric and gynaecological care, mentoring new health workers and expanding their scope of practice. However, the generally poor status of records documenting healthcare provision limits their usability in evaluation and research.
Highlights
Most sub-Saharan African countries have too few reproductive health (RH) specialists, resulting in high RH-related mortality and morbidity
clinical officer(s)–reproductive health (CORH) have a more extensive clinical exposure during training (6 months as interns, in addition to 3 months during their basic training) and a more sustained presence at their workstations, making them reliable resource persons in RH for other medical workers. This is significant given that the objective of the initiators of the Conclusions Training of CORH is effective in directly increasing human resources for specialist RH healthcare
CORH contribute to RH specialist care through support they give to others in the field, by training and mentoring new health workers, including medical officers and medical officer interns
Summary
Most sub-Saharan African countries have too few reproductive health (RH) specialists, resulting in high RH-related mortality and morbidity. Few countries in sub-Saharan Africa have adequate resources or sufficient skilled health workers to provide critical, evidence-based interventions that improve reproductive health (RH) and reduce maternal mortality [2]. Task sharing (or task shifting) is a strategy that countries around the world employ to address gaps in access and availability caused by a shortage of physicians. This strategy creates cadres of associate clinicians who perform what would traditionally be part of a physician’s job. In 2008, associate clinicians, previously known as non-physician clinicians, were used in 25 out of 47 countries in sub-Saharan Africa [3]
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