title: Use of surgical task shifting to scale up essential surgical services: a feasibility analysis at facility level in Uganda.
abstract: BACKGROUND
  The shortage and mal-distribution of surgical specialists in sub-Saharan African countries is born out of shortage of individuals choosing a surgical career, limited training capacity, inadequate remuneration, and reluctance on the part of professionals to work in rural and remote areas, among other reasons. This study set out to assess the views of clinicians and managers on the use of task shifting as an effective way of alleviating shortages of skilled personnel at a facility level.
  
  
  METHODS
  37 in-depth interviews with key informants and 24 focus group discussions were held to collect qualitative data, with a total of 80 healthcare managers and frontline health workers at 24 sites in 15 districts. Quantitative and descriptive facility data were also collected, including operating room log sheets to identify the most commonly conducted operations.
  
  
  RESULTS
  Most health facility managers and health workers supported surgical task shifting and some health workers practiced it. The practice is primarily driven by a shortage of human resources for health. Personnel expressed reluctance to engage in surgical task shifting in the absence of a regulatory mechanism or guiding policy. Those in favor of surgical task shifting regarded it as a potential solution to the lack of skilled personnel. Those who opposed it saw it as an approach that could reduce the quality of care and weaken the health system in the long term by opening it to unregulated practice and abuse of privilege. There were enough patient numbers and basic infrastructure to support training across all facilities for surgical task shifting.
  
  
  CONCLUSIONS
  Whereas surgical task shifting was viewed as a short-term measure alongside efforts to train and retain adequate numbers of surgical specialists, efforts to upscale its use were widely encouraged.
authors.affiliation: Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill Road, Kampala, Uganda. mosesg@img.co.ug
authors.forename: Moses
authors.initials: M
authors.lastname: Galukande
authors.forename: Sam
authors.initials: S
authors.lastname: Kaggwa
authors.forename: Patrick
authors.initials: P
authors.lastname: Sekimpi
authors.forename: Othman
authors.initials: O
authors.lastname: Kakaire
authors.forename: Achilles
authors.initials: A
authors.lastname: Katamba
authors.forename: Ian
authors.initials: I
authors.lastname: Munabi
authors.forename: Francis Mwesigye
authors.initials: FM
authors.lastname: Runumi
authors.forename: Ed
authors.initials: E
authors.lastname: Mills
authors.forename: Amy
authors.initials: A
authors.lastname: Hagopian
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Blair
authors.forename: Scott
authors.initials: S
authors.lastname: Barnhart
authors.forename: Sam
authors.initials: S
authors.lastname: Luboga
mesh_terms: D003151:Community Health Centers; D005240:Feasibility Studies; D017144:Focus Groups; D013502:General Surgery; D006297:Health Services Accessibility; D006761:Hospitals; D006801:Humans; D010561:Personnel Staffing and Scheduling; D036301:Qualitative Research; D019035:Rural Health Services; D014454:Uganda; D000078329:Workforce
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