a1 Makerere University
The Problem: There is a shortage and maldistribution of medically trained health professionals to deliver cost-effective maternal and child health (MCH) services. Hence, cost-effective MCH services are not available to over half the population of Uganda and progress toward the Millennium Development Goals for MCH is slow. Optimizing the roles of less specialized health workers (“task shifting”) is one strategy to address the shortage and maldistribution of more specialized health professionals.
Policy Options: (i) Lay health workers (community health workers) may reduce morbidity and mortality in children under five and neonates; and training for traditional birth attendants may improve perinatal outcomes and appropriate referrals. (ii) Nursing assistants in facilities might increase the time available from nurses, midwives, and doctors to provide care that requires more training. (iii) Nurses and midwives to deliver cost-effective MCH interventions in areas where there is a shortage of doctors. (iv) Drug dispensers to promote and deliver cost-effective MCH interventions and improve the quality of the services they provide. The costs and cost-effectiveness of all four options are uncertain. Given the limitations of the currently available evidence, rigorous evaluation and monitoring of resource use and activities is warranted for all four options.
Implementation Strategies: A clear policy on optimizing health worker roles. Community mobilization and reduction of out-of-pocket costs to improve mothers’ knowledge and care-seeking behaviors, continuing education, and incentives to ensure health workers are competent and motivated, and community referral and transport schemes for MCH care are needed.
(Online publication March 30 2011)
This report was produced under the Supporting Use of Research Evidence (SURE) for Policy in African Health Systems, which is a collaborative project that builds on and supports the Evidence-Informed Policy Network (EVIPNet) in Africa and the Regional East African Community Health (REACH) Policy Initiative. SURE is funded by the European Commission's 7th Framework Programme. The authors are funded in part by the International Development Research Centre, Canada under the International Research Chairs Initiative. Technical support for the preparation of this evidence brief was provided by the Norwegian Knowledge Centre for the Health Services, World Health Organisation (Department of Research Policy Cooperation), McMaster University (Canada), Ministry of Health (Uganda) and Makerere University (Uganda).
Preparation of this report was coordinated and facilitated by Dr Andy Oxman. The authors would like to thank Nelson Sewankambo, John Lule, Charles Karamagi, Charles Isabirye, Miriam Sentongo, John Lavis, Kaelan Moat, Dela Dovlo, Yoswa Dambisya, Metin Gulmezoglu, Susan Munabi Babigumira and Simon Lewin for reviewing earlier versions of the report.