A severe shortage of trained medical personnel is one of the many challenges to providing healthcare at a local level across Africa.
Task-shifting — permitting less specialised people to carry out certain functions — is one proposal to overcome this, but it is meeting resistance.
In Uganda community health workers may soon be allowed to give contraceptive injections in a strategy geared towards meeting family planning needs.
The same plan has so far been rejected in Kenya. In both Kenya and Uganda thousands of trained nurses are either unemployed, or are working in sectors not related to their profession.
Kenyan government records show the country has more than 8 000 unemployed nurses — even though the public health system reports a
shortfall of 44 000 nurses.
‘We are concerned about the need for more healthcare workers in our healthcare facilities,” says Dr Francis Kimani, Kenya’s director of medical services, explaining that financial constraints have led to positions remaining unfilled.
‘But the government has implemented an arrangement known as [the] economic stimulus programme, through which 4 200 nurses have already been interviewed and will be employed by
March. In January we recruited 400 nurses and they will be posted to various workstations any time now.”
But, Kimani says, the government will not allow community-based workers to take on a function previously reserved for nurses, despite the acute shortage of trained professionals in healthcare facilities countrywide.
Kimani argues that allowing nonprofessionals to give contraceptive injections could compromise service delivery; infection is one risk, failing to recognise when the contraceptive is contra-indicated is another.
But non-governmental organisations working in the health sector argue that evidence suggests the best and cheapest method of providing healthcare at the local level is by shifting tasks to community health workers.