Task-shifting: experiences and opinions of health workers in Mozambique and Zambia

The consequences of staff deficits include heavier workloads for those on duty, the closure of some services, loss of quality and hazards for health workers and managers. This paper describes the task-shifting taking place in health centers and district hospitals in Mozambique and Zambia, aiming to determine the positive and negative consequences of this phenomenon.

The paper illustrates that in both the Republic of Mozambique and the Republic of Zambia, health workers have to practice beyond the traditional scope of their professional practice to cope with their daily tasks.

Findings contain:

• health workers practice task-shifting to ensure that their patients receive the level of care that they deem due to them, even in the absence of written instructions
• the "out of professional scope" activities consume a significant amount of working time
• subsidiary staff and nurses are the two cadres assuming a greater diversity of functions as a result of improvised task-shifting.

Conclusions are as follows:

• task-shifting is openly acknowledged and widespread, informal and carries risks for patients, staff and management
• task-shifting alone cannot respond to the needs of poor countries, especially if other issues are not addressed at the same time
• these issues may include inadequate facilities, lack of equipment, lack of transport for field work, lack of accommodation for staff, and inadequate continuing education efforts, among others
• it seems that workers have clear ideas about how to improve the availability of services, but it remains to be seen if decision-makers will listen to them.