Department of Health Policy, Planning and Management, Makerere University College of Health Sciences, School of Public Health, P.O Box 7072, Kampala, Uganda.
Quality Assurance Directorate, Makerere University, P.O Box 7072, Kampala, Uganda.
Hum Resour Health. 2018 May 2;16(1):20. doi: 10.1186/s12960-018-0282-z.
Documented evidence shows that task shifting has been practiced in Uganda to bridge the gaps in the health workers' numbers since 1918. The objectives of this study were to provide a synthesis of the available evidence on task shifting in Uganda; to establish levels of understanding, perceptions on task shifting and acceptability from the decision and policy makers' perspective; and to provide recommendations on the implications of task shifting for the health of the population in Ugandan and human resource management policy.
This was a qualitative study. Data collection involved review of published and unpublished literature, key informant interviews and group discussion for stakeholders in policy and decision making positions. Data was analyzed by thematic content analysis (ethical clearance number: SS 2444).
Task shifting was implemented with minimal compliance to the WHO recommendations and guidelines. Uganda does not have a national policy and guidelines on task shifting. Task shifting was unacceptable to majority of policy and decision makers mainly because less-skilled health workers were perceived to be incompetent due to cases of failed minor surgery, inappropriate medicine use, overwork, and inadequate support supervision.
Task shifting has been implemented in Uganda for a long time without policy guidance and regulation. Policy makers were not in support of task shifting because it was perceived to put patients at risk of drug abuse, development of drug resistance, and surgical complications. Evidence showed the presence of unemployed higher-skilled health workers in Uganda. They could not be absorbed into public service because of the low wage bill and lack of political commitment to do so. Less-skilled health workers were remarked to be incompetent and already overworked; yet, the support supervision and continuous medical education systems were not well resourced and effective. Hiring the existing unemployed higher-skilled health workers, fully implementing the human resource motivation and retention strategy, and enforcing the bonding policy for Government-sponsored graduates were recommended.
有文献记录表明，自 1918 年以来，乌干达一直在实践工作任务分担，以弥补卫生工作者人数的不足。本研究的目的是综合现有关于乌干达工作任务分担的证据；从决策者的角度了解、理解和感知工作任务分担的水平，以及对人口健康和人力资源管理政策的影响。
这是一项定性研究。数据收集包括对已发表和未发表文献的审查、对政策和决策制定利益攸关方的关键知情人访谈和小组讨论。通过主题内容分析进行数据分析（伦理审查编号：SS 2444）。
工作任务分担的实施几乎没有遵守世卫组织的建议和准则。乌干达没有关于工作任务分担的国家政策和准则。大多数政策和决策者都不接受工作任务分担，主要是因为技能较低的卫生工作者被认为能力不足，因为他们曾出现过小型手术失败、用药不当、过度劳累和支持监督不足的情况。
乌干达长期以来一直在没有政策指导和监管的情况下实施工作任务分担。政策制定者不支持工作任务分担，因为这被认为会使患者面临药物滥用、耐药性发展和手术并发症的风险。证据表明，乌干达存在失业的高技能卫生工作者。由于工资支出低，缺乏政治承诺，他们无法被吸收到公共服务部门。技能较低的卫生工作者被认为能力不足且已经过度劳累；然而，支持监督和持续医学教育系统的资源和效果不佳。建议招聘现有的失业高技能卫生工作者，全面实施人力资源激励和保留战略，并执行政府资助毕业生的担保政策。
