Abstract
BackgroundThe shortage of health professionals in low income countries is recognized as a crisis. Community health workers are part of a “task-shift” strategy to address this crisis. Task shifting in this paper refers to the delegation of tasks from health professionals to lay, trained volunteers. In Kenya, there is a debate as to whether these volunteers should be compensated, and what motivation strategies would be effective in different socio-demographic contexts, based type of tasks shifted. The purpose of this study was to find out, from stakeholders’ perspectives, the type of tasks to be shifted to community health workers and the appropriate strategies to motivate and retain them.MethodsThis was an analytical comparative study employing qualitative methods: key informant interviews with health policy makers, managers, and service providers, and focus group discussions with community health workers and service consumers, to explore their perspectives on tasks to be shifted and appropriate motivation strategies.ResultsThe study found that there were tasks to be shifted and motivation strategies that were common to all three contexts. Common tasks were promotive, preventive, and simple curative services. Common motivation strategies were supportive supervision, means of identification, equitable allocation of resources, training, compensation, recognition, and evidence based community dialogue.Further, in the nomadic and peri-urban sites, community health workers had assumed curative services beyond the range provided for in the Kenyan task shifting policy. This was explained to be influenced by lack of access to care due to distance to health facilities, population movement, and scarcity of health providers in the nomadic setting and the harsh economic realities in peri-urban set up. Therefore, their motivation strategies included training on curative skills, technical support, and resources for curative care. Data collection was viewed as an important task in the rural site, but was not recognized as priority in nomadic and peri-urban sites, where they sought monetary compensation for data collection.ConclusionsThe study concluded that inclusion of curative tasks for community health workers, particularly in nomadic contexts, is inevitable but raises the need for accreditation of their training and regulation of their tasks.
Highlights
The shortage of health professionals in low income countries is recognized as a crisis
Managers viewed it as tasks that can be performed by lower cadres such as Community Health Workers (CHWs)
Community health workers described it as “tasks performed by nurses lowered to be performed by CHWs,” stated by a CHW focus group discussant
Summary
The shortage of health professionals in low income countries is recognized as a crisis. Community health workers are part of a “task-shift” strategy to address this crisis. Task shifting in this paper refers to the delegation of tasks from health professionals to lay, trained volunteers. The purpose of this study was to find out, from stakeholders’ perspectives, the type of tasks to be shifted to community health workers and the appropriate strategies to motivate and retain them. Task shifting refers to the rational redistribution of tasks from health professionals to community health workers in order to improve access to care and optimize the use of limited human resources. Community Health Workers, that are trained lay volunteers, are an important part of a “task-shift” strategy and may help address the growing crisis of health worker shortages [3,4]. CHWs have acted as a bridge between formal health systems and the community [4], enabling health programmes to achieve three interconnected goals: building a relationship between the health care provider and the community; improving appropriate health care utilization; and educating people to reduce health risks in their lives [6]
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