This presentation discusses enabling clinical officers in Uganda to provide tubal ligations to address workforce shortages. There is a shortage of healthcare workers in Uganda, with only 1 worker per 625 people compared to the WHO recommendation of 1 per 435. Currently 62% of doctor positions are vacant. The presentation outlines the rationale for task sharing based on shortages and uneven distribution. It also describes a study that assessed complications and client satisfaction for tubal ligations performed by clinical officers, finding low complication rates and over 99% of clients rating the procedure as good or very good. The conclusions recommend allowing clinical officers to specialize in family planning services including tubal ligations or adding tubal ligations to their national curriculum.

1. Task
Sharing
Enabling Clinical Officers
to provide tubal ligations
Presenter:
Amy Rwakihembo
Senior Manager
External Relations
Marie Stopes Uganda
This presentation is made possible by the support from the American People through the United States Agency for International Development (USAID).
The contents are the responsibility of MSI and do not necessary reflect the views of USAID or the United States Government
SLIDE 1

2. Global Health Workforce

WHO recommendation:
1 HW per 435

Uganda:
HW per 625

62% of Ugandan doctor
positions vacant
1
(Human Resources for Health 2012)
Task Sharing- Enabling Clinical Officers to provide tubal ligations
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3. Rationale
• National shortage of health workers, or their uneven
distribution across a country or region….
• Difficulties ensuring staff retention of higher cadres in
certain settings, such as rural areas….
• To reduce the salary cost of providing services….
• To free the time of higher cadre health workers so that
they may focus on services requiring a higher level of
technical proficiency….
Task Sharing- Enabling Clinical Officers to provide tubal ligations
SLIDE 3

4. MOH Leadership
• Chairman- MCH TWG leadership (Dr Nsugwa)
• Ag. Assistant Commissioner MoH (Dr Collins
Tusingwire_
Task Sharing- Enabling Clinical Officers to provide tubal ligations
SLIDE 4

5. WHO guidance on task
sharing family planning
LHWs
Tubal
Ligation
Vasectomy
Auxiliary
Nurses
Auxiliary
Midwives
Nurses
Midwives
Associate
Clinicians
Doctors
Not Recommended
With Rigorous Research
IUDs
Implants
Injectables
With M&E
Recommended
OCPs &
Condoms
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6. Methods
• March – June 2012, a clinical audit of 518 TLs was
conducted at rural HCIIIs and IVs public health sites to:
 To assess intra- and post-operative complications
associated with CO provision of TL in non-clinical
settings
 To evaluate client satisfaction levels associated with
CO provision of TL
Task Sharing- Enabling Clinical Officers to provide tubal ligations
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7. Main Findings/Comparisons –
adverse events
Overall complication rate (major adverse events) - 1.5%
Baseline: 2 major AEs – perforation and failure to mobilize tubes;
[pain experienced by ½ the women]
Day 3: 1.9% complications (pain; fever; poor wound healing; infection)
Day 7: 0.2% complications (pain)
Day 45: no complications
Task Sharing- Enabling Clinical Officers to provide tubal ligations
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8. Main findings – Client satisfaction
Client acceptability
Good/very good rating of the TL
procedure received
Good/very good rating of overall
experience at the facility
Woman would recommend
service to a friend based on
experience
Day 3
(N=484)
Day 7
(N=485)
Day 45
(N=484)
% (N)
91.5 (443)
% (N)
93.8 (454)
% (N)
99.2 (475)
94.2 (451)
96.5 (466)
99.0 (475)
92.8 (449)
95.5 (463)
97.5 (471)
Over 99% rated the TL procedure performed by a CO in
outreach facility as good or very good
Over 97% would recommend service to a friend
Task Sharing- Enabling Clinical Officers to provide tubal ligations
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9. Conclusions/
Recommendations
Conclusions
Ugandan COs perform TL at least as well or better compared
to providers in other countries
Recommendations
a) Allowing COs the option of specialising in FP service
delivery, including surgical methods
And/or…
b) Scoping the addition of TL to the CO national curriculum
Task Sharing- Enabling Clinical Officers to provide tubal ligations
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10. Thank You
Task Sharing- Enabling Clinical Officers to provide tubal ligations
SLIDE 10