Implications of task shifting on power relations in healthcare: the case of clinical officers at public hospitals in Malawi

Abstract

In Malawi, there exists a group of medical professionals known as clinical officers (COs) who assume responsibilities typically carried out by doctors due to the current scarcity of the latter. This paper seeks to explain how the introduction of COs as part of implementing task shifting in healthcare, unintentionally became a terrain for the contestation of power between COs and physicians. The research from which this paper originates used a qualitative research approach. It was carried out in state-owned facilities, encompassing four district hospitals and one central hospital in Malawi. This paper develops a conceptual framework on power and then uses it to demonstrate that task shifting through the introduction of COs as substitutes for physicians, became a source of interprofessional conflicts. The paper argues that unequal power relations between COs and physicians in healthcare contribute to interprofessional conflicts. The paper further demonstrates that unequal power relations between COs and physicians are manifested through differences in educational backgrounds and work experiences as well as unequal responsibility and authority. The paper concludes that the interprofessional conflicts between COs and physicians arising from unequal power relations ultimately aggravate poor psychosocial well-being among COs.