Task Shifting, a Strategic Response to the Healthcare Human Resource Crises: A Qualitative Study of Hospital Based HIV Clinics in North Central Nigeria

Tuesday, 13 July 2010: 11:10 AM

Ezebuihe Ihuoma, RN, MSN, MPH
PAHO/Global Health Deptment, University of Maryland, Baltimore, MD
Irene Ekwede, RN, MSN
PAHO/Global Health Dept, University of Maryland, Washington, DC
Caroline Orwenyo, RN, MSN
PAHO/Global Health Dept, University of Maryland, Baltimore, MD
Emilia Ngozi Iwu, RN, BSN, MSN
School of Nursing, University of Maryland, Baltimore, Baltimore, MD
Rosemary F. Riel, MAA
Office of Global Health, School of Nursing, University of Maryland, Baltimore, Baltimore, MD

Learning Objective 1: Identify 3 factors affecting task shifting implementation process and benefits by HCWs.

Learning Objective 2: Describe three recommended strategies to enhance implementation process of task shifting.

Purpose: The purpose of the study was to understand factors influencing the implementation of the TS process by HCWs

Methods: Qualitative focus group study utilizing focus groups and personal interview with key informants was conducted separately among physicians and nurses in the HIV clinics of two tertiary teaching hospitals in Abuja Nigeria to investigate factors influencing implementation of the TS process. Data was digitally recorded, transcribed and analyzed to identify factors influencing TS process


  1. TS benefitted patients by decreasing wait time and increasing amount and perceived quality of care received which improved patient satisfaction and lowered risk of losing patients to follow-up.
  1. TS benefitted HCWs by decreasing physician workload and increasing amount of time spent with more complex patients. Nurses reported their expanded roles provided them new knowledge and skills that improved patient care.
  2. TS altered inter-professional dynamics.  Nurses expressed improved relations based on increased respect for their patient care contribution.  Physicians perceived nurses as challenging their status by “over-stepping” boundaries.

HCWs require more preparation to successfully implement TS. Nurses require more clinical training to manage ART patients.  Physicians need a better introduction to the task-shifting process.  More participatory implementation methods are needed to increase awareness, improve execution, increase multi-disciplinary communication, and clearly define new roles that TS creates for all HCWs including auxiliary, laboratory and pharmacy staff.