title: Human resource constraints and the prospect of task-sharing among community health workers for the detection of early signs of pre-eclampsia in Ogun State, Nigeria.
abstract: BACKGROUND
  The dearth of health personnel in low income countries has attracted global attention. Ways as to how health care services can be delivered in a more efficient and effective way using available health personnel are being explored. Task-sharing expands the responsibilities of low-cadre health workers and allows them to share these responsibilities with highly qualified health care providers in an effort to best utilize available human resources. This is appropriate in a country like Nigeria where there is a shortage of qualified health professionals and a huge burden of maternal mortality resulting from obstetric complications like pre-eclampsia. This study examines the prospect for task-sharing among Community Health Extension Workers (CHEW) for the detection of early signs of pre-eclampsia, in Ogun State, Nigeria.
  
  
  METHODS
  This study is part of a larger community-based trial evaluating the acceptability of community treatment for severe pre-eclampsia in Ogun State, Nigeria. Data was collected between 2011 and 2012 using focus group discussions; seven with CHEWs (n = 71), three with male decision-makers (n = 35), six with community leaders (n = 68), and one with member of the Society of Obstetricians and Gynaecologists of Nigeria (n = 9). In addition, interviews were conducted with the heads of the local government administration (n = 4), directors of planning (n = 4), medical officers (n = 4), and Chief Nursing Officers (n = 4). Qualitative data were analysed using NVivo version 10.0 3 computer software.
  
  
  RESULTS
  The non-availability of health personnel is a major challenge, and has resulted in a high proportion of facility-based care performed by CHEWs. As a result, CHEWs often take on roles that are designated for senior health workers. This role expansion has exposed CHEWs to the basics of obstetric care, and has resulted in informal task-sharing among the health workers. The knowledge and ability of CHEWs to perform basic clinical assessments, such as measure blood pressure is not in doubt. Nevertheless, there were divergent views by senior and junior cadres of health practitioners about CHEWs' abilities in providing obstetric care. Similarly, there were concerns by various stakeholders, particularly the CHEWs themselves, on the regulatory restrictions placed on them by the Standing Order.
  
  
  CONCLUSIONS
  Generally, the extent to which obstetric tasks could be shifted to community health workers will be determined by the training provided and the extent to which the observed barriers are addressed.
  
  
  BACKGROUND
  NCT01911494.
authors.affiliation: Department of Sociology, University of Lagos, Lagos, Nigeria. davidakeju@gmail.com.
authors.forename: David O
authors.initials: DO
authors.lastname: Akeju
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, V5Z 4H4, Canada.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vidler
authors.affiliation: Department of Obstetrics and Gynaecology, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria.
authors.forename: J O
authors.initials: JO
authors.lastname: Sotunsa
authors.affiliation: Centre for Research in Reproductive Health, Sagamu, Nigeria.
authors.forename: M O
authors.initials: MO
authors.lastname: Osiberu
authors.affiliation: Centre for Research in Reproductive Health, Sagamu, Nigeria.
authors.forename: E O
authors.initials: EO
authors.lastname: Orenuga
authors.affiliation: Centre for Research in Reproductive Health, Sagamu, Nigeria.
authors.forename: Olufemi T
authors.initials: OT
authors.lastname: Oladapo
authors.affiliation: Centre for Research in Reproductive Health, Sagamu, Nigeria.
authors.forename: A A
authors.initials: AA
authors.lastname: Adepoju
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Rahat
authors.initials: R
authors.lastname: Qureshi
authors.affiliation: Department of Research, Vancouver Island Health Authority, Victoria, V8R 1 J8, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Sawchuck
authors.affiliation: Department of Obstetrics and Gynaecology, OlabisiOnabanjo University, Sagamu, Nigeria.
authors.forename: Olalekan O
authors.initials: OO
authors.lastname: Adetoro
authors.affiliation: Department of Obstetrics and Gynaecology, St George's University London, London, SW17 0RE, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Centre for Research in Reproductive Health, Sagamu, Nigeria.
authors.forename: Olukayode A
authors.initials: OA
authors.lastname: Dada
mesh_terms: D003150:Community Health Workers; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D008297:Male; D009549:Nigeria; D017410:Practice Guidelines as Topic / Q000592:standards*; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000517:prevention & control; D011247:Pregnancy; D036301:Qualitative Research
keywords: Community health extension workers; Nigeria; Pre-eclampsia; Task-sharing