Quality of healthcare provided in a task-shifting health system: Experience from a mobile health service in a southern African country




Poster session 1 Wednesday: Evidence production and synthesis


Wednesday 13 September 2017 - 12:30 to 14:00


All authors in correct order:

Esoimeme G1
1 University of South Carolina, USA
Presenting author and contact person

Presenting author:

Gloria Esoimeme

Contact person:

Abstract text
Background: Task-shifting is an innovative approach to expand healthcare delivery in settings with limited healthcare personnel. The World Health Organization defines task-shifting as "a process in which specific tasks are moved, where appropriate, to health workers with shorter training and fewer qualifications". Three mobile clinics in Namibia, run by a non-profit organisation utilise a task-shifting healthcare delivery model by employing nurses to provide services to people in remote areas at specified locations bi-monthly. Each clinic comprises of 2 nurses and a driver who performs administrative duties.

Objective: To assess the quality of services provided by a mobile health clinic run by nurses and the potential of reproducing this healthcare delivery model in other resource-limited countries. 

Methods: The three constructs (structure, process and outcomes) from the Donabedian model for measuring healthcare quality was applied to this evaluation; structure (vehicle, staff, schedule, fees); process (form and methods of service provision) and outcomes (treatment, referral, recurrence). Methods employed in this evaluation include: 1) review of 103 randomly selected consultation notes and comparison of the notes with the requirements in Namibia’s Standard Treatment Guidelines; 2) Direct observation of practices in the mobile clinics; and, 3) Interviews with patients, mobile clinic staff, staff in the Ministry of Health and other stakeholders. 

Results: The mobile health clinics had about 5000 visits annually and patients found it convenient that the mobile clinic schedule was predictable. Most cases seen were primary care cases and were managed according to the recommendation in the Namibian Standard Treatment Guidelines. However, standard definitions were not employed in categorising the diagnosis and there was overutilisation of antibiotics.

Conclusions: This model of healthcare delivery was effective in reaching remote areas and can be reproduced in most resource-limited settings. However, it would require regular reviews and re-training of nurses to provide the highest quality of care in line with the Standard Treatment Guidelines.