title: Task shifting in maternal and child health care: an evidence brief for Uganda.
abstract: OBJECTIVE
  There is a shortage and maldistribution of medically trained health professionals to deliver cost-effective maternal and child health (MCH) services. Hence, cost-effective MCH services are not available to over half the population of Uganda and progress toward the Millennium Development Goals for MCH is slow. Optimizing the roles of less specialized health workers ("task shifting") is one strategy to address the shortage and maldistribution of more specialized health professionals.
  (i) Lay health workers (community health workers) may reduce morbidity and mortality in children under five and neonates; and training for traditional birth attendants may improve perinatal outcomes and appropriate referrals. (ii) Nursing assistants in facilities might increase the time available from nurses, midwives, and doctors to provide care that requires more training. (iii) Nurses and midwives to deliver cost-effective MCH interventions in areas where there is a shortage of doctors. (iv) Drug dispensers to promote and deliver cost-effective MCH interventions and improve the quality of the services they provide. The costs and cost-effectiveness of all four options are uncertain. Given the limitations of the currently available evidence, rigorous evaluation and monitoring of resource use and activities is warranted for all four options.
  A clear policy on optimizing health worker roles. Community mobilization and reduction of out-of-pocket costs to improve mothers' knowledge and care-seeking behaviors, continuing education, and incentives to ensure health workers are competent and motivated, and community referral and transport schemes for MCH care are needed.
authors: Supporting Use of Research Evidence for Policy (SURE Project), Office of Principal, College of Health Sciences, Makerere University, New Mulago Hospital Complex, P.O. Box 7072, Kampala, Uganda. hnabudere@gmail.com
authors: Harriet
authors: H
authors: Nabudere
authors: Delius
authors: D
authors: Asiimwe
authors: Rhona
authors: R
authors: Mijumbi
mesh_terms: D000293:Adolescent; D002648:Child; D002654:Child Care / Q000191:economics*; D002669:Child Welfare; D002675:Child, Preschool; D003153:Community Health Services; D003256:Community Participation / Q000191:economics*; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine / Q000191:economics*; D005260:Female; D014943:Global Health; D006040:Goals; D006282:Health Personnel / Q000191:economics*; D006291:Health Policy / Q000191:economics; D006301:Health Services Needs and Demand / Q000191:economics*; D006801:Humans; D007223:Infant; D007398:Interpersonal Relations; D008297:Male; D008430:Maternal-Child Health Centers / Q000191:economics*; D008880:Midwifery; D009726:Nurses; D024382:Professional Role; D014454:Uganda