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Task SharingEnabling Clinical Officers to provide tubal ligations

Presenter:Amy RwakihemboSenior ManagerExternal RelationsMarie Stopes Uganda

This presentation is made possible by the support from the American People through the United States Agency for International Development (USAID). The contents are the responsibility of MSI and do not necessary reflect the views of USAID or the United States Government

SLIDE 2Task Sharing- Enabling Clinical Officers to provide tubal ligations

Global Health Workforce

WHO recommendation: 1 HW per 435

Uganda: 1 HW per 625

62% of Ugandan doctor positions vacant (Human Resources for Health 2012)

SLIDE 3Task Sharing- Enabling Clinical Officers to provide tubal ligations

Rationale• National shortage of health workers, or their uneven

distribution across a country or region….

• Difficulties ensuring staff retention of higher cadres in certain settings, such as rural areas….

• To reduce the salary cost of providing services….

• To free the time of higher cadre health workers so that they may focus on services requiring a higher level of technical proficiency….

SLIDE 4Task Sharing- Enabling Clinical Officers to provide tubal ligations

MOH Leadership

• Chairman- MCH TWG leadership (Dr Nsugwa)

• Ag. Assistant Commissioner MoH (Dr Collins Tusingwire_

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WHO guidance on task sharing family planning

 

  LHWs AuxiliaryNurses

AuxiliaryMidwives

Nurses Midwives AssociateClinicians

Doctors

Tubal Ligation

             

Vasectomy              

IUDs              

Implants              

Injectables              

OCPs & Condoms

             

Recommended

With M&E

With Rigorous Research

Not Recommended

SLIDE 6Task Sharing- Enabling Clinical Officers to provide tubal ligations

Methods

• March – June 2012, a clinical audit of 518 TLs was conducted at rural HCIIIs and IVs public health sites to:

To assess intra- and post-operative complications associated with CO provision of TL in non-clinical settings

To evaluate client satisfaction levels associated with CO provision of TL

SLIDE 7Task Sharing- Enabling Clinical Officers to provide tubal ligations

Main Findings/Comparisons – adverse events

Overall complication rate (major adverse events) - 1.5%

Baseline: 2 major AEs – perforation and failure to mobilize tubes; [pain experienced by ½ the women]

Day 3: 1.9% complications (pain; fever; poor wound healing; infection)

Day 7: 0.2% complications (pain)

Day 45: no complications

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Main findings – Client satisfaction

Client acceptability Day 3 (N=484)

Day 7 (N=485)

Day 45 (N=484)

% (N) % (N) % (N) Good/very good rating of the TL procedure received

91.5 (443) 93.8 (454) 99.2 (475)

Good/very good rating of overall experience at the facility

94.2 (451) 96.5 (466) 99.0 (475)

Woman would recommend service to a friend based on experience

92.8 (449) 95.5 (463) 97.5 (471)

Over 99% rated the TL procedure performed by a CO in outreach facility as good or very good

Over 97% would recommend service to a friend

SLIDE 9Task Sharing- Enabling Clinical Officers to provide tubal ligations

Conclusions/ Recommendations

Conclusions

Ugandan COs perform TL at least as well or better compared to providers in other countries

Recommendations

a) Allowing COs the option of specialising in FP service delivery, including surgical methods

And/or…

b) Scoping the addition of TL to the CO national curriculum

SLIDE 10Task Sharing- Enabling Clinical Officers to provide tubal ligations

Thank You