Use of surgical task shifting to scale up essential surgical services: a feasibility analysis at facility level in Uganda

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Date
2013Author
Galukande, Moses
Kaggwa, Sam
Sekimpi, Patrick
Kakaire, Othman
Katamba, Achilles
Munabi, Ian
Mwesigye Runumi, Francis
Hagopian, Amy
Blair, Geoffrey
Barnhart, Scott
Luboga, Sam
Mills, Ed.
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The shortage and mal-distribution of surgical specialists in sub-Saharan African countries is born out
of shortage of individuals choosing a surgical career, limited training capacity, inadequate remuneration, and
reluctance on the part of professionals to work in rural and remote areas, among other reasons. This study set out
to assess the views of clinicians and managers on the use of task shifting as an effective way of alleviating
shortages of skilled personnel at a facility level.
Methods: 37 in-depth interviews with key informants and 24 focus group discussions were held to collect
qualitative data, with a total of 80 healthcare managers and frontline health workers at 24 sites in 15 districts.
Quantitative and descriptive facility data were also collected, including operating room log sheets to identify the
most commonly conducted operations.
Results: Most health facility managers and health workers supported surgical task shifting and some health workers
practiced it. The practice is primarily driven by a shortage of human resources for health. Personnel expressed
reluctance to engage in surgical task shifting in the absence of a regulatory mechanism or guiding policy. Those in
favor of surgical task shifting regarded it as a potential solution to the lack of skilled personnel. Those who opposed
it saw it as an approach that could reduce the quality of care and weaken the health system in the long term by
opening it to unregulated practice and abuse of privilege. There were enough patient numbers and basic
infrastructure to support training across all facilities for surgical task shifting.
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- Medical and Health Sciences [3670]