Task Shifting in Rural Tanzania: Characteristics and Quality Implications of Semi-Skilled Health Staff Serving in Lindi and Mtwara Regions

Abstract

Background: Due to severe and critical shortage of health professionals lower level health facilities in Tanzania, notably Dispensaries, depend on medical attendants/semi-skilled health workers for service provision. This paper reports on characteristics of these semi-skilled health staff, their performance of tasks, and related implications for quality of health services in Lindi and Mtwara regions. Methods:This was essentially a cross-sectional, descriptive fact finding study. Its implementation followed a triangulated methodological approach. That is, both quantitative and qualitative approaches in data collection and analysis were employed.Results: About two thirds, 146 (61.4%), of the studied Medical Attendants had a primary level of education. Most of them at most attended a one year course in basic nursing; Kilwa and Liwale districts lead by far in having more than half of the studied facilities manned entirely by Medical Attendants. Examination of their scheme of service versus the tasks they engage in indicated glaring gaps calling for interim quality improvement measures. Current supervisory visits by members of the Council Health Management Team (CHMT) are mainly administrative -offering limited or no clinical support. Conclusion:The situation of delivery of health services by semi-skilled staff in the rural Dispensaries amounts to an unmanaged task shifting. The implications of this fact on quality of services rendered to the poor rural residents are overwhelming. There is need for the Ministry of Health and Social Welfare to develop a policy and guideline that will recognize the important role played by Medical Attendants and shed light on how their work performance can be improved.

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“…Health system functioning issues and challenges which were reported in this study also need to be urgently addressed. They included distance to health facilities, anti-malarial stock outs, health financing and cost related to seeking care which led to dissatisfaction with the CHF services, and absenteeism of health workers which compounds the already understaffed health facilities in resource-limited settings [ 50 , 51 ]…”

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“…Health cadres such as nurses, laboratory personnel and medical attendants were included in the study due to the reason that they provide supportive functions that significantly influence patient outcomes and diagnostics [27]. In health-staff-short countries like Tanzania, task shifting is common, where laboratory personnel's, medical attendants and nurses often take on clinician roles [28][29][30][31].…”

“…Nurses take on the role of implementing treatments, monitoring vital signs and overseeing progress of patients. In regions facing a shortage of healthcare workers, roles typically carried out by clinicians are often taken up by nurses, laboratory personnel, and sometimes medical attendants [30,31,66]. In general, good patient outcomes are a result of interdisciplinary collaboration between clinicians and support staffs [67][68][69][70].…”