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

The dearth of health personnel in low income countries has attracted global attention. Among the top challenges being addressed are issues as to how health care services can be delivered in a more effective and efficient manner using available health personnel. Task-sharing is one innovative approach that makes this possible [1, 2]. It is the process which allows low-cadre and mid-level healthcare professionals to provide safely clinical tasks and procedures that would otherwise be restricted to higher level cadres [1, 2]. It has been used to improve access to contraceptives in Canada [2], HIV Care and ART services in Zambia [3], and in rural Malawi [4], and other health services in low and middle-income countries (LMIC) where there are widespread shortages of qualified health professionals [1–4]. This approach expands the responsibilities of low-cadre health personnel in an effort to best utilize available human resources [1, 2]. The shortage of health care providers is due to poor reform in the health system that could expand the number of trained health care workers, as well as address the “brain drain” phenomenon in Nigeria [5]. In 2006, the World Health Organization (WHO) estimated a global shortage of 4.3 million health workers, with poorer countries in the Global south particularly hard-hit [6].

Maternal mortality remains a grave concern globally with 210 maternal deaths per 100,000 live births in 2013 [7, 8]. Nigeria has one of the highest maternal mortality ratios at 560 per 100,000 live births [7]. The hypertensive disorders of pregnancy, including pre-eclampsia, are responsible for a large number of these preventable deaths. Although no antenatal remedy is available for pre-eclampsia, timely identification and management greatly decreases the likelihood of severe morbidity and death. Prompt identification of pre-eclampsia through reliable blood pressure and proteinuria measurement, emergency treatment with MgSO₄ and antihypertensive agents, and timely referral enables many women and babies tof be saved.

Despite that Nigeria has one of the largest stocks of health workers in Africa, the density of nurses, midwives, doctors, and community health workers is too low to effectively deliver essential health services to the whole population. Inconsistent recruitment policies and the brain drain have led to a huge burden in health care delivery for the disproportionate number of employed health workers. Various cadres of health workers provide services in Nigeria. The Community Health Extension Worker (CHEW) provides primary health care services, it is expected that they spend 60 % of their time on community-based functions and 40 % on clinic-based functions. CHEW training is 2–3 years, and the curriculum is mainly focused on community diagnosis and treatment of minor ailment and diseases; assisting mid-level health workers in providing care at health facilities; and community outreach. There are no courses specifically dedicated to the hypertensive disorders of pregnancy in the CHEWs training curriculum; however, a course on reproductive health provides an overview of pregnancy and its complications. Objectives of the reproductive health course are to understand the concept of reproductive health and rights, including family planning, the process of pregnancy formation and development, the management of labour, and the care of the mother and child during puerperium. Other courses that could provide a foundation that might be relevant in the management of pregnancy hypertension include clinical skills and supervised clinical experience.

Within this context, it is important to investigate the potential for task-sharing to community health workers with specific reference to the provision of screening and detection of early signs of pre-eclampsia. The aim of this study is to identify the facilitators and barriers to the task-sharing of these services by the CHEWs in Nigeria.