Uganda’s ministry of health has just started implementing a new five-year Health Sector Development Plan (HSDP); the main goal of the HSDP is to accelerate movement towards Universal Health Coverage (UHC). To achieve this goal, health workforce is very critical; Uganda' health worker to population ratio is currently at 14/10,000. This is far below the World Health Organization (WHO) recommendation of 23/10,000. There is a clear health worker crisis in Uganda that is not only characterized by inadequate numbers, but also inadequate skill-mix, uneven geographical distribution, less health worker motivation, attraction and retention, and high attrition rates. Health worker absenteeism and poor performance have widely been reported. Overall, Uganda’s health sector staffing situation is below the established standards. Only about 70% of established positions in public facilities are filled. This challenge is even worse in rural areas, where most of the population live. At an estimated annual population growth rate of 3.02%, Uganda’s population is projected to be 57.7 million by 2030. Delivering health services to this projected population will require about 132,000 additional health workers above the current stock.

To address the health worker shortages, task-shifting has been implemented in Uganda’s health care system. With task-shifting, specific tasks are moved from highly qualified health workers to less qualified (low level) cadres. The WHO in 2007, issued recommendations and guidelines to implement task shifting without compromising quality. Consequently, in Uganda, tasks have been shifted from doctors and specialised physicians to clinicians, or from non-physician clinicians to nurses and midwives, and from nurses and midwives to nursing assistants. With task shifting, registered and enrolled nurses have taken on increasingly more roles of doctors and specialised physicians such as, capturing patient history, performing clinical examinations, making diagnoses, and prescribing medication. Task-shifting has successfully been implemented in the area of HIV/AIDS including in Uganda. One study done at the Infectious Disease Institute (IDI) in Mulago, there was no need of a specialised doctor to offer ARVs at an HIV clinic, rather, lower level cadres could successfully do this. The study concluded that task-shifting may reduce workforce shortages, optimize patient care, and might help large HIV/AIDS clinics in Uganda and other low-income countries to cope with increasing numbers of patients seeking care.

However, before task shifting, it is important to recognize the capacities and skills of the lower cadres who may be required to take on certain roles. The Uganda Service Delivery Indicators Survey (USDI) conducted in 2013 revealed that about 20% of nurses/midwives, and nearly 60% of nursing assistants and public health officers, could not accurately identify most common diseases such as acute diarrhoea, pneumonia, diabetes mellitus, pulmonary tuberculosis and malaria with anaemia. This means that lower cadres may not be qualified enough to undertake professional tasks of clinical nature assigned to them. This would subsequently undermine the quality of service delivery. Furthermore, implementing task-shifting, requires establishment of necessary policy and regulatory frameworks. However, it is often argued that strict adherence to these guidelines is more expensive than undertaking new recruitment of qualified health workers. This is because the time and resources required to prepare health workers to successfully perform delegated tasks is enormous. Task shifting is currently being implemented in Uganda, but there is not yet a policy that streamlines its implementation, coordination and supervision.

There is evidence that task-shifting could address some human resource challenges in the health sector. However to optimize the benefits of task-shifting, continuous training, retraining and support supervision of health personnel is fundamental to guarantee quality healthcare and the safety of health service consumers. Furthermore, curriculum review for the training of lower cadres with a view of including the likely duties to be task-shifted would be a critical step in realizing the benefits of task-shifting. More importantly however, government should realize that while task-shifting may offer short to medium term solutions, it is not the panacea to the health worker crisis in Uganda. Government should prioritize recruitment and deployment of the currently unemployed, yet well-trained health workers, create mechanisms to enhance motivation and retention, including through financial incentives, improved living conditions, and guaranteeing a safe and conducive working environment.

First Publsihed by New Vision- Friday July 22, 2016