The Prospect of Task-Shifting among Community Health Workers for Emergency Management of Pre-eclampsia in Nigeria.

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Akeju, D.O
Vilder, M
Oladapo, O.T
Adetoro, O.O
Von Dadelszen, P
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Task-shifting redistributes responsibilities from highl y qualified providers to lower level cadres i n an effort to best uti lize avail able human resou rces. This becom es more appropri ate i n a country like Nigeria where there is a shortage of quali fied health professionals and a .huge burden of matern a l mortal i ty resulti ng from obstetric compl i cati ons l i ke pre-eclam psi a and eclampsi a. Th i s stud y exam ines the p rospect for task-shi fting among CHEW for em ergency m an agem ent o f pre-eclampsi a, in Ogun State, Nigeria Th i s study is part of a larger communi ty-based trial evaluating the acceptabi l i ty of comm un i ty t reatmen t for severe pre-eclam psi a i n -Ni geri a. Focus group d i scussions (FG D) and i n-d epth i n terviews (IDI) were cond ucted from 2012-to-201 3. Ei ght focus groups were held wi th CHEWs ( =64), four wi th male decision-makers (N=32), five wi t h com m u n i ty leaders (rel i gious and representati ves of trad itional rulers and pol i t ical groups) (N=56). In add i t i on, i n terv i ews were conducted wi th the heads of the local government admini stration (N=4), Medical Officers of Health (N=4), Heads of local government administration (N=4), and Chief Nursi ng Officers (N=4). Qualitative data were translated into Engl i sh by local researchers wi th fl uency i n Yo ru ba and Engl i sh. Data were subsequently analysed usi ng. NVivo versi on I 0.0 3 computer software. The non-availabi lity of personnel, which is a major challenge among al l cad res of heal th care wo rkers has resu lted i nto faci lity-based pract ice for CHEWs. As a resu l t, CHE Ws often get i n vol ved i n tasks that are meant for health workers in the senior cadre. Thi s l evel of i nvol vem en t has exposed them to some of the basics of obstetric care necessary to safeguard wom en seeki ng obstetri c care; leading to a kind of informal task-shifti ng among the heal t h workers. Th e knowledge and ability of CHEWs to take blood measurement is not in doubt. Nevertheless, there were d i vergent vi ews across the senior and ju ni or cadres of heal th practi t i oners about task­ sh i ft i ng of obstet ri c care to CHEWs as a result of certa i n ban-iers. Sim i l arly, th ere were concerns by va ri ous stakehold ers, particul arly the CHEWs themsel ves, on the regu l atory rest ri ct ions placed on the by the Standing Order. Genera ll y, the extent to which obstetric task could be shifted to commu ni ty heal th workers, w i l l be detennined, by and large, by the type of trai ning provided to CHEWs and the extent to wh i ch some of t h e observed baITiers are addressed. Of importance is train i ng in ohstetri c care and the i n c l u sion o f certai n areas of obstet ri c care whi ch has not been i ncl uded i n the Stand i ng Order.
Paper presented at the 9th International Scientific Congress of the Society for Obstetrics and Gynecology of Nigeria.
Task-shifting , Pre-eclampsia , Community health workers