Performance of trained clinical officers in reproductive health service delivery through task shifting: opportunities and its challenges in Kenya

Abstract

The world is experiencing a chronic shortage of well-trained health workers with a global deficit of doctors, nurses and midwives being approximately 2.4 million, and with low- and middle income countries having acute human resource crisis. Human workforce Health crisis in Sub-Saharan Africa has been due to the critical shortage especially of the doctors, nurses and mid-wives. To alleviate this shortages, task shifting was recommended in 2004 and approved by the World Health Organization in 2008 in Addis Ababa. In Kenya, under the policy of skills transfer, clinical officers, were trained and task shifted as from 2002 to perform emergency obstetrical and gynecological procedures in order to fill the gaps left by the doctors. The purpose of this study was to determine the performance, challenges and the opportunities in task shifting for the trained clinical officers in reproductive health. The specific objectives of the study was to determine the level of competence, motivational challenges, regulatory, working and policy environment. This was a cross-sectional study design that used both quantitative and qualitative approaches for data collection. Seven selected counties of Muranga, Nairobi, Kakamega, Kisii, Mombasa, Machakos and Nakuru were used for study. To trace the respondents, purposive, snowballing sampling technique was employed. Structured questionnaires were administered and triangulated by both focus group discussions and key informant interviews. Qualitative data was analyzed through content analysis. Performance was measured by observing how well the officer performed a particular procedure besides record retrieval of previously performed operations. The researcher reviewed literature from previous records on trends in reproductive health services since the inception of task shifted clinical officers in 2004. One hundred and fifty clinical officers were targeted for study. A sample of 45 reproductive health clinical officers was captured for study calculated as 30% of the target population for cluster group surveys. The study found out that motivation builds a better, more satisfied and better performing workforce as evidenced by response of further training (66%), provision of housing at facility (53.33%), recognition as specialist (66.66%), increase in service utilization such as ANC (53.34%, deliveries (86.67%), good outcomes in deliveries (80%) and obstetrical operations (93.33%). There was significant statistical evidence of competence in performing task shifted obstetrical and gynecological procedures at p-value 0.05, computed chi-square value of 7.134 against the critical value of 9.488. Sixty six respondents agreed that there was reduced maternal mortality rate as reflected in 2014 Kenya demographic Health survey, increased number of hospital deliveries and good delivery outcomes. Analysis of Variance with a computed value of 95.7, p-value 0.05 and critical value of 2.45 indicated that responses from despondence differed significantly while response for anew act of parliament for the practice of new skills was 100%. The study concluded that the performance level of competence for clinical officers was high and that there existed reasonable degree of motivation and career opportunities for the cadre. The study recommended for the development of task shifting policy framework for the cadre, sensitization of workforce at health facilities on the concept of task shifting and enactment of act of parliament to cater and allow for the independent practice of new skills.