A scoping study on task shifting; the case of Uganda

Area of Science:

• Health Policy and Systems Research
• Human Resources for Health
• Qualitative Health Research

Background:

• Task shifting has been a long-standing practice in Uganda's health sector, yet remains largely undocumented.
• Existing literature provides limited insight into the experiences and perceptions of task shifting among key stakeholders.

Purpose of the Study:

• To gather evidence on task shifting experiences in Uganda.
• To assess the acceptability and perceptions of task shifting among health managers and policymakers.
• To formulate evidence-based recommendations for health workforce policy.

Main Methods:

• A qualitative research design was employed.
• Data were collected through a comprehensive review of published and gray literature.
• Key informant interviews were conducted with health policy and decision-making stakeholders in Uganda.

Main Results:

• Task shifting is integral to health service delivery in Uganda, with lower-cadre health workers undertaking roles of specialized professionals.
• The practice is informal, lacking a dedicated policy and guidelines, and faces concerns regarding the competence and workload of lower-cadre staff.
• Arguments for task shifting emphasize existing practice and the need for policy support, while opponents cite incompetence, overwork, and cost concerns.

Conclusions:

• Task shifting was largely deemed unacceptable by health managers and policymakers due to perceived incompetence, overwork, and inadequate support supervision for lower-cadre health workers.
• Recommendations include recruiting unemployed trained health workers, enhancing motivation and retention strategies, and implementing mandatory service periods for graduates.