On July 14, I attended the Washington, DC, SIFPO2 Project event “Expanding Access to LARCs and Permanent Methods through Task Sharing.” While HC3 does work to increase youth access to long-acting reversible contraceptive methods (LARCs), and task sharing is something certainly on our collective radar as a promising practice in family planning (FP), HC3 hasn’t yet worked specifically on FP task sharing. I took with me to the event, therefore, one open-ended question: What role can social and behavior change communication (SBCC) play in task sharing for better FP outcomes?
Marie Stopes International (MSI) classifies task sharing as “the process of enabling lay and mid-level healthcare professionals – such as nurses, midwives, clinical officers and community health workers – to provide clinical services and procedures, that would otherwise be restricted to higher level cadres, safely.”
Task sharing – previously and sometimes alternately referred to as task shifting – is often embraced to overcome any number of health system challenges, including: human resource issues (e.g., doctor shortages or high clinical staff turnover rates), financial resource issues (e.g., when increasing the number of high-cost doctors is less feasible than hiring less expensive community health workers) and service provision inequities (e.g., when urban areas receive disproportionately higher coverage rates compared to rural areas).
At the event last week, presenters explained how in Ethiopia, training community health extension workers to insert implants has pushed a previously clinic-relegated procedure out to rural women’s doorsteps – and has increased reach to young and first-time FP users. In Guatemala, auxiliary nurses at SIFPO facilities are being trained to insert IUDs and implants to expand the tier of health workers who can provide these services. In Uganda and Zambia, clinical officers are learning from higher trained professionals to perform tubal ligations. All of this means expanded access to long-acting and permanent contraception, which is great for women living with an unmet need for FP. But with these promising improvements come some troubling drawbacks.
In certain contexts, higher-tier medical professionals and associations are concerned and upset at their duties being assigned to “lower-level” providers, and worry this might threaten their jobs. Clients, too, worry that less-trained or lower-cadre providers should not be trusted to take on the work of a highly-skilled doctor or similar professionals. One presenter noted that regardless of task sharing among professionals, client fears continued to hover more around a procedure itself – in this case, tubal ligation – rather than around who would perform the service. Finally, event participants discussed how to ensure that task-sharing activities were implemented according to need and in concert with demand generation to avoid creating more demand than available services, or more services available than demand.
Any one or combination of these challenges could undermine FP task sharing success. But in each of these challenges, are also SBCC opportunities: Opportunities to encourage provider values clarification and calls to action to help providers accept “lower” health professionals as colleagues for positive change, rather than threats; opportunities to improve counseling resources for lower cadre health professionals to help build rapport with their clients and address service-related fears or misconceptions; opportunities to help clients trust that they will receive quality information and care from these newly trained professionals; opportunities to create client demand for FP services to be delivered by more accessible tiers of professionals in their community… The list goes on.
While my hand was not among those raised when meeting facilitators asked, “Who in this room is currently working on task sharing?”, I was happy to be in the room networking with organizations and offices who were, promoting HC3’s tools that can certainly contribute to task sharing achievements in FP moving forward.
Are you working on task-sharing in FP? See our below resources, which include adaptable provider-focused counseling materials, method-specific SBCC posters and brochures and other tools to help allay fears and misconceptions around FP for a variety of audiences. For more information on how you can fold these into your task-sharing activities, contact Erin Portillo or Allison Mobley.
- LARC SBCC materials for youth and providers
- Healthy timing and spacing of pregnancy – addressing advanced maternal age and high-parity pregnancy
Sign up for HC3’s newsletter to be notified of upcoming resources on using SBCC for provider behavior change and service delivery, which can also be used to support task-sharing activities.