By Ibrahim Sha’aban
For a long time now in Nigeria, maternal mortality, morbidity, childbirth complications and other negative healthcare indices have continued to soar higher as the country is being subjected to a natural haemorrhage of health professionals who tend to seek greener pastures abroad or ensconce themselves in the urban areas of the country. According to statistics, 20 doctors, nurses and midwives are to attend to 10,000 Nigerians.
Apparently disturbed by this phenomenon, the Federal Ministry of Health, in 2014, came up with a national policy called Task Shifting, Task Sharing (TSTS) to promote rational distribution or delegation of tasks from the highly qualified health workers to the junior ones who have been trained in order to widen up access to healthcare services across the nooks and crannies of the country.
The policy is also intended to provide a legal framework or backing to enable Community Healthcare Extension Workers (CHEWs) to provide quality maternal and new-born healthcare as well as family planning services, especially at the Primary Healthcare Centres in the country.
Other areas which this framework is expected to cover include, but not limited to, epidemic or communicable diseases like the HIV/AIDS and other sexually transmitted infections, tuberculosis and leprosy diseases.
According to a report obtained by DAILY NIGERIAN, within the four years in which the policy has existed, the country’s health ministry, in collaboration with its supporting partners under the Partnership for Advocacy in Child and Family Health (PACFAH at Scale), have significantly dissipated energies towards the success of the policy. However, precious as the policy sounds, it, regrettably, met with resistance and other challenges across some states in the country.
The statistics show that, four years after, only 22 out of the 36 states of the country have adopted the policy and are currently at different levels of implementation. The rest neither are nonchalant nor unimpressed about the policy. With this, it is clear that some states are not committed to the policy.
Other challenges the document observed include funding challenges and a professional rivalry between doctors, nurses and CHEWS, with the former feeling threatened by an encroachment into his territorial grounds by the activities of the latter. For instance, a doctor would feel threatened if a trained CHEW attends to, or deliver pregnancies and so on.
To address these clogs in the policy’s wheel of progression, the policy, as it had roundly been observed, needed a review. To this end, PACFAH at Scale, in conjunction with the country’s health ministry, recently convened a stakeholders workshop in Abuja with all other implementing Civil Society Organisations (CSOs) view to brainstorming on the way forward.
In an interview with DAILY NIGERIAN during the event, Senior Technical Advisor to PACFaH@Scale Project, Dr Emmanuel Abanida said that the workshop was a follow up to a successful stakeholders’ consultative meeting for the review of the TSTS policy held on June 4-8, 2018.
He disclosed that the main reasons for the workshop was to expand knowledge of the status of initiatives to monitor the state of implementation and revise the 2014 TS policy, increase awareness of the role of CSOs and Professional Associations as monitors within an accountability framework for effective TSTS implementation and strengthened linkages between service delivery and advocacy in TS implementation.
Mr Abanida added that participants are also expected to increase their awareness of the programs and activities of development partners working to implement TSTS policy at the national level as well as expand their knowledge of challenges and gaps in TS implementation at the state level.
“As we might all be aware, Nigeria is set to review the 2014 Task Shifting and Task Sharing Policy (TSTS) in 2018. The Task shifting and task sharing policy in the health sector is a global recommendation by the World Health Organization (WHO) designed to ensure equitable distribution of quality essential health care services in Human Resources for Health (HRH) constrained regions of the World,” he added.
While elaborating on the concept of TSTS policy, Mr Abanida explained that the policy is a process of delegation, whereby tasks are moved from highly specialized to less specialized health workers.
According to him, when properly done, the policy can make more efficient and effective use of the human resources for Health sector currently available by reallocating tasks among front-line health care workers.
During their deliberation, the participating CSOs unanimously reaffirmed that in order to address the shortage and gap in human resource in the sector, Task Shifting/Sharing is the only option available. They further noted that women and children are dying daily due to lack of competent health practitioners around their localities. According to them, large percentages of qualified doctors in the country are concentrated in the urban cities while the rural populace is left at the mercy of a few nurses and unqualified CHEWs.
- 65% of Nigerians lack proper access to healthcare services.
- 70% rural populace have no access to healthcare services.
- Nigeria needs about 237,000 Medical Doctors.
- Nigeria currently has 35,000 doctors only.
- Nigeria has as low as152,000 Nurses and midwives.
To this end, they recommended that there is a need for the CHEWs who have ‘volunteered’ to stay back to be adequately trained, supervised and mentored in order to do the job well. They also called on the government at all levels to take ownership of the policy and support it through adequate funding and sustainability.
However, some participants expressed their fears over the policy, thinking that the policy could create room for more quackery, indiscipline and malpractices in the health sector.
Earlier in his remark, the Director/Head of Reproductive Health Division at the Federal Ministry of Health, Dr Kayode Afolabi, tasked the stakeholders on coming up with a viable policy document in order to provide efficient health care services, especially in the hard-to-reach areas of the country.
He stressed that adequate training of frontline health workers is a major way of curbing health risks which some described as a weakness of the policy.
One of the participants, Halima Muqaddas, the Executive Director of Women, Children and Youths’ Health and Education Initiative, said the policy is grassroots-friendly and would go a long way in catering to the healthcare needs of the rural populace.
She said: “If you critically look at it, especially in the Northern part of Nigeria, like Bauchi State where I come from, eighty percent of the people live in rural areas and we know that the primary health care facilities in those rural areas are being manned by frontline healthcare workers like Community Healthcare Officers (CHOs) and Community Health Extension Workers (CHEWs).
“So, we this policy, communities at the grassroots will get the necessary healthcare services. For example, if a woman wants to go in for a normal delivery, she will have a health care provider that is trained and licensed to provide that service.
“However, once complications begin to set in, she will be referred appropriately to the next line of care. That is what is all about Task Shifting and Task Sharing.”
She added: “I know that a lot of professionals have reservations because they are protecting their territorial ground, but we cannot continue to deceive ourselves. In so many villages and rural areas, you don’t see a nurse, a doctor or even a midwife but if a CHEW is there, fine and good.
“When the individual is properly trained, he or she will be able to at least access whether the woman has risks of complications or a woman is going to have a normal delivery and advise her appropriately.”