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Task shifting - a strategic response to human resource for health crisis: qualitative evaluation of hospital based HIV clinics in North central Nigeria
Presented by Emilia Iwu (United States).
E. Iwu1,2, I. Ekwede3, I. Ezebuihe4, O. Caroline3, E. Umaru5, A. Gomwalk5, M. Moen6, R. Riel4, J. Johnson7
1Universit of Maryland, School of Nursing & School of Medicine, Family & Community Nursing, Office of Global Health, Baltimore, United States, 2Institute of Human Virology Nigeria, Community Medicine, Abuja, Nigeria, 3University of Maryland, School of Nursing, Office of Global Health, Baltimore, United States, 4University of Maryland, School of Nursing, Office of Global Health, Baltimore, United States, 5University of Maryland, School of Medicine, Institute of Human Virology, Nigeria, Abuja, Nigeria, 6University of Maryland, School of Nursing, Family & Community Health, Baltimore, United States, 7University of Maryland, School of Nursing, Family & Community Health, Office of Global Health, Baltimore, United States
Issues: Global HCW shortage challenges Millennium Development Goal for universal access to HIV/AIDS treatment. In Nigeria, approximately 552,000 PLHAs lack access to ART with only 14% PMTCT coverage. Task-shifting (TS) involves redistribution of non-traditional roles to HCWs with lower qualifications to expand access to services. Our studies sought to understand influencing factors, professional roles and working conditions related to and the impact of TS from doctors to nurses in Nigeria.
Description: Using clinic observations, surveys, task/patient flow analysis, focus groups, we piloted TS at an HIV clinic with > 8,000 clients in Abuja, Nigeria. We developed curriculum, tools, trained and mentored providers to work as a team to implement ART refills by nurses. We also conducted focus group discussions among nurses (n=27), doctors (n=12), individual interviews of nursing and medical administrators (n=7) at two tertiary hospitals. Data was recorded transcribed and analyzed to identify common themes.
Lessons learned: Task-shifting decreased: waiting time/clinic hours (62% & 41%) and physician workload (41%). It increased amount/quality of time for new and complicated cases. Nurses reported >100% increase in work load but “gained additional knowledge and skills” to provide in-depth care. Amount/quality of care provided and provider/patient satisfaction were improved. Inter-professional dynamics were altered as nurses expressed improved relationship and respect from patients; some physicians perceived nurses as challenging (“over-stepped boundaries”); pharmacists initially refused to honor prescriptions from nurses. Despite the small sample size, task shifting appears to be a viable strategy in lieu of HRH resolutions. Communication skills, team building, training and mentoring are critical elements for successful implementation. Nurses required additional clinical training/mentoring for ARV refill and monitoring while doctors benefitted from training on TS concepts/process and mentoring. Roles had to be clearly defined and other affected HCWs carried along.
Next steps: Ongoing mentoring, quantitative assessment of care/patient outcomes, scale up and advocacy for supportive policies.
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