Abstract
BackgroundDocumented evidence shows that task shifting has been practiced in Uganda to bridge the gaps in the health workers’ numbers since 1918. The objectives of this study were to provide a synthesis of the available evidence on task shifting in Uganda; to establish levels of understanding, perceptions on task shifting and acceptability from the decision and policy makers’ perspective; and to provide recommendations on the implications of task shifting for the health of the population in Ugandan and human resource management policy.MethodsThis was a qualitative study. Data collection involved review of published and unpublished literature, key informant interviews and group discussion for stakeholders in policy and decision making positions. Data was analyzed by thematic content analysis (ethical clearance number: SS 2444).ResultsTask shifting was implemented with minimal compliance to the WHO recommendations and guidelines. Uganda does not have a national policy and guidelines on task shifting. Task shifting was unacceptable to majority of policy and decision makers mainly because less-skilled health workers were perceived to be incompetent due to cases of failed minor surgery, inappropriate medicine use, overwork, and inadequate support supervision.ConclusionsTask shifting has been implemented in Uganda for a long time without policy guidance and regulation. Policy makers were not in support of task shifting because it was perceived to put patients at risk of drug abuse, development of drug resistance, and surgical complications.Evidence showed the presence of unemployed higher-skilled health workers in Uganda. They could not be absorbed into public service because of the low wage bill and lack of political commitment to do so.Less-skilled health workers were remarked to be incompetent and already overworked; yet, the support supervision and continuous medical education systems were not well resourced and effective.Hiring the existing unemployed higher-skilled health workers, fully implementing the human resource motivation and retention strategy, and enforcing the bonding policy for Government-sponsored graduates were recommended.
Highlights
Documented evidence shows that task shifting has been practiced in Uganda to bridge the gaps in the health workers’ numbers since 1918
To provide recommendations on the implications of task shifting for the health of the population in Ugandan and human resource management policy
The health sector faced an enormous shortage of higher skilled health workers
Summary
Documented evidence shows that task shifting has been practiced in Uganda to bridge the gaps in the health workers’ numbers since 1918. Task shifting has been practiced in many countries for years as a means to address the shortage of higherskilled health workers [1,2,3]. Shortage of higher-skilled health workers is a global quandary [3,4,5,6]. It is worst in low- and middle-income economies (including Uganda). The causes are complex and range from failure to train adequate numbers of skilled health workers, failure to attract and retain them, deaths, migration, to complex political-socio-economic contexts. Benefit packages, and job satisfaction cause migration of health workers in search of better packages from other countries, the private sector within countries, and others exit the health sector [10,11,12].
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