Bill & Melinda Gates Foundation

Tasksharing in Ethiopia: A Midwife Can Do That Now

December 11, 2012

The World Health Organization has published new ‘tasksharing’ guidelines on maternal and newborn healthcare that recommend governments enable more health workers below the level of doctor to provide key maternal and newborn health (MNH) care services including family planning. 

In Ethiopia, doctors are very scarce. There is only one doctor for every 30,000 people, and the doctors there are mostly work in cities like Addis Ababa, leaving men and women in rural areas in dire need of important health services, including family planning.

Ethiopia isn’t unique in this situation: many less developed countries have the same problem. We are unique in what we’re doing about it though.

Part of our solution is tasksharing, a popular word in global health but perhaps not well understood outside of these circles. Put simply, it is when we train mid and lower level health professionals like midwives, health officers and community health workers to perform procedures that previously only doctors could do.

 Getting tasksharing up and running does take some work, but from my position here in southern Ethiopia, I can say that it is worth it, and that it works.
These types of health professionals are more likely to live in rural areas, so they can offer vital health services like family planning to communities where there is no doctor.

It sounds like a simple solution, but as always things are more complex than they seem. First, governments must have policies in place that are supportive of tasksharing, and allow mid and lower level providers to carry out certain procedures.

Then doctors need to be convinced that these lower level health professionals can, for example, perform a tubal ligation to the same standard that they can. Training packages need to be drawn up, and doctors need to carefully monitor the health professionals while they are training.

So getting tasksharing up and running does take some work, but from my position here in southern Ethiopia, where I am an outreach team leader, I can say that it is worth it, and that it works.

My team is based in Awasa, where Marie Stopes International Ethiopia have a centre: the team is made up of myself (a nurse), a driver, a surgical assistant and a health officer called Asfawossen. Each week the four of us drive to two or three rural villages and set up a mini-clinic at the community health centre, returning back to Awasa to sterilise equipment and replenish our stocks in between each trip.

At each village we offer a full range of family planning services to the women and men who come to see us, including long term and permanent methods like contraceptive implants and tubal ligation.

These are methods we can only offer here because of tasksharing. In the case of implants, community health extension workers can now insert them, and for tubal ligations health officers like Asfawossen can now perform them, having received extensive training to add to their three or four years general medical and surgical experience.

Last week we visited a small village called Tefere Kele. Many of the women we see there are relatively young, 25 or 26 years old but they have six or seven children already, having become a mother for the first time at a very early age.

This is the first time that long term and permanent family planning methods have been available to them close to home, and after counselling we find that tubal ligation is the choice for many, because it means women no longer have to worry about getting their next stock of pills, or getting to the clinic to have their three monthly injection.

The reason why Zelalem Tsegaye (pictured above), a woman who visited us recently, chose a tubal ligation was typical:

“I have 6 children already. I want to look after them properly. I want to take care of myself … that’s why I opted for a tubal ligation.”

Her story is typical right across Ethiopia. Since we began training health officers to perform tubal ligation, the number of locations where can offer women this option has increased by 400 percent, and the number of women choosing it has increased by 120 percent.

There are many other less developed countries like Ethiopia, where doctors are scarce and unevenly distributed. Men and women in all of these countries could benefit if tasksharing is implemented in line with World Health Organisation recommendations, as it has been here. If tasksharing is to be rolled out across the world, in the countries that need it most, supportive government policies are crucial, along with international funding and the backing of key clinicians.  Now, the government of Ethiopia  has a policy on tasksharing and is committed to national scale-up.

Here at Marie Stopes International Ethiopia, we believe that tasksharing can play a big part in bringing crucial sexual and reproductive health services to those most in need. It’s working in Ethiopia.

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