Task shifting and implications for newborn care

GLOBAL CONFERENCE ON NEWBORN HEALTH. 14-18 April 2013 Johannesburg, South Africa
Dr Assumpta Muriithi Newborn Health Family and Reproductive Health, Health Promotion Cluster (HPR) WHO/AFRO

Outline
Background
Status of newborn health

Mortality levels Coverage of effective interventions MNCH Health workforce challenges WHO recommendations on task shifting Implications for newborn care

Status of newborn survival

Neonatal deaths account for 40% (3.1 million) of global

under-five mortality
38% (1.1 million) of those deaths are from the Sub-

Saharan region

Major causes of death in neonates and children underfive in the African Region, 2010

Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)

Critical shortage of health service providers (doctors, nurses and midwives)

World Health Report, 2006

100%

20%

40%

60%

80%

0%
an s

Ph ys i ci Nu rs es M id wi ve s De nt i st s Te ch /A ss Ph Ph ar ar m m ac ac i st i st s s Te ch /A ss La b wo rk Ra er s En di og v. ra he ph al er th /P s H wo rk er s De nt i st CH

Rural

Urban

W s

Way forward from "What" to "How

What
The need to improve access and quality health care for

mothers, newborns and children along the continuum of care Through having people, with the right skills in the right place, at the right time

How
Optimizing the role of available health workers or task

shifting is an option

through building competencies for the required skills and having the required supportive environment

Available evidence shows that task shifting has been in

existence since the 1960s but without much documentation and with no guidance.
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WHO Recommendations on task shifting.

Outlined in the WHO 2012 publication on Optimizing health workers

role to improve access to key maternal and newborn health interventions through task shifting, OPTIMIZEMNH

Developed to address the identified need to optimize potential of the

existing health workforce. Objective: to issue evidence based recommendations to facilitate universal access to key MNCH interventions through optimization of health workers role.
Developed through use of evidence by a multi-stakeholder taskforce

The process included:

(i) identification of priority questions and critical outcomes; (ii) retrieval of the evidence; (iii) assessment and synthesis of the evidence iv) Presentation of evidence using structured health systems framework. (iv) formulation of recommendations.

Categories of Recommendations
4 categories
Recommendation-should be considered for

implementation. Recommendation with targeted monitoring and evaluation Recommendation only in the context of rigorous research Recommended against practice should not be considered for implementation
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Implication for newborn health

The guideline recommendations: Includes maternal, newborn interventions together with contraceptives and HIV/PMTCT Clarifies Lay Health Workers (LHW) roles in health promotion and preventive aspects for newborns Includes recommendations and skills for care of the newborn for other cadres of health workers: auxiliary nurses, midwives and associate clinicians (Non-physician clinicians)
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Implications for newborn health

Direct implications include Good care practices for the mother during pregnancy, delivery and postnatal period:
Promotion of ANC and skilled delivery Postnatal care including family planning

Care for the newborn Home based care for newborns including promotion of breastfeeding, cord care, recognition of danger signs Better care seeking practices for the newborns.
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Key messages for Task shifting

In the application of WHO recommendations the following should be considered: Context
Need an initial situation analysis of numbers and skills of

the existing health workers (HW). Empower the HW being assigned the new roles All stakeholders must be involved

Institutionalization and sustainability Ensure policies, structures, funds, processes are in place Identify informal task shifting already taking place and formalize it. Consider including some of the successful practices into the pre-service training.
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Key messages cont..

Communication and advocacy Ensure communication on the process of optimizing for maternal and newborn health is to all stakeholders. Advocate with all stakeholders for support in optimizing for health service delivery. Monitoring and evaluation Agree on key measurable indicators for monitoring progress especially focusing on improved access to health interventions. Monitor and evaluate policy implementation and identify and address challenges and bottlenecks. Documentation Document and share lessons learnt.
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Conclusion
We need to scale up interventions for newborn health at all levels but there is inadequate

human resources in the region. Evidence exists to support task shifting recommendations. Task shifting must be context specific with close monitoring. A large number of task shifting options still require rigorous research to build up the required evidence.
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Thank you