Task Shifting on Provision of Contraceptives and Abortion Services in Maternal and Reproductive Health in Sub-Saharan Africa to achieve Universal Health Coverage: A Narrative Review

Abstract

Introduction: Improving maternal and reproductive health is a target for Sustainable Development Goals 3. Accessibility to contraceptives and abortion services is important in improving maternal and reproductive health. In 2014 in sub-Saharan Africa, over 40% of women aged 15-49 years wanted to avoid pregnancy but only 50% or 55 million of these could access contraceptives. Shortage of skilled health workers, which is worse in Africa, has been associated with these challenges. Universal Health Coverage (UHC) is a target for world nations. To achieve UHC adequate skilled healthcare workers is one key factor needed. In 2013, globally, this shortage was 7.2 million and projected to be 12.9 million by 2035. Task shifting has been thought as a possible solution to this shortage. Therefore, the objective of this review is to establish the outcome of task shifting in the provision of contraceptives and abortion services in sub-Saharan Africa. Methods: A systematic approach was adopted. Medline, PsycINFO, EBM Reviews databases were searched. Google scholar and hand searching bibliographies of retrieved studies were also done. A quality appraisal using Mixed Method Appraisal Tool was done. Data were extracted using a customized form and themes identified. A narrative synthesis of the results was reported. Results: A total of 319 records were retrieved and a set inclusion and exclusion criteria eleven studies were included in the final analysis. The quality of studies was poor as only one random control trial was retrieved limiting the quality of the evidence. Results suggest that task shifting may be a safe and effective method inimproving contraceptives and abortion service accessibility in sub-Saharan Africa. Conclusion: To cover healthcare staff shortages task shifting of contraceptive and abortion services can be considered in healthcare practices and included national human resource policies. Further research is required to cover gaps in long-term outcome these services.