Does inter-border conflict influence the views of task sharing among community health volunteers in Nigeria? A qualitative study

Abstract

Background Volunteer community health workers are increasingly being engaged in Nigeria, through the World Health Organization’s task sharing strategy. This strategy aims to address gaps in human resources for health, including inequitable distribution of health workers. Recent conflicts in rural and fragile border communities in northcentral Nigeria create challenges for volunteer community health workers to meet their community's increasing health needs. This study aimed to explore the perception of volunteers involved in task sharing to understand factors affecting performance and delivery in such contexts. Methods This was a qualitative study conducted in fragile border communities in north central Nigeria. Eighteen audio recorded, semi-structured interviews with volunteers and supervisors were performed. Their perceptions on how task sharing and allocation of tasks affect performance and delivery were elucidated. The transactional social framework was applied during the thematic analysis process to generate an explanatory account of the research data, which was analysed using NVivo software. Results Promotive and preventive tasks were shared among the predominantly agrarian respondents. There was a structured task allocation process that linked the community with the health system and mainly cordial relationships were in place. However, there were barriers related to ethnoreligious crises and current conflict, timing of task allocations, gender inequities in volunteerism, shortage of commodities, inadequate incentives, dwindling community support and negative attitudes of some volunteers. Conclusion The perception of task sharing was mainly positive, despite the challenges, especially the current conflict. In this fragile context, reconsideration of non-seasonal task allocations within improved community-driven selection and security systems should be encouraged. Supportive supervision and providing adequate and timely renumeration will also be beneficial in this fragile setting.

Human Resources for Health in Conflict Affected Settings: A Scoping Review of Primary Peer Reviewed Publications 2016–2022

“…Lar et al described that heightened intercommunal tensions in Nigeria made communities more suspicious of community health workers (CHWs) from outside the main ethno-religious group, which narrowed the potential scope of people to be deployed. 38 When it proved not possible to recruit specific cadres or types of HCWs, a common policy response was recruitment and deployment of CHWs. CHWs programmes can be effective when CHWs receive appropriate training, supervision and other support.…”

“… 18 In Yemen and Nigeria, offering services in areas other than CHWs’ and supervisors’ village of residence, became a problem. 38 , 41 In Afghanistan, safety on the roads was a problem for particularly female CHWs. 45 In DRC, ethnic grouping on either side of the conflict generated patient distrust of HCWs or between each other, which sometimes compromised HCWs’ attitudes towards particular ethnic groups.…”