Background

The Federal Ministry of Health, in collaboration with Development Policy Research Center (dPRC), with the support of Bill and Melinda Gates Foundation held a 1- day NGO/CSOs Stakeholders’ engagement on the 19^th of July, 2018.

The objective of the meeting was to discuss the existing task shifting and sharing policy (TSSP), identify gaps, barriers to effective implementation and provide recommendations as well as consider future implementation considerations.

Participants at the meeting included representation from the Federal Ministry of Health, National Primary Health Care Development Agency, Society of Gynecology and Obstetrics of Nigeria (SOGON), Pediatrics Association of Nigeria (PAN), Nursing and Midwifery Council of Nigeria, dPRC, World Health Organization, Gates Foundation, DFID, USAID, South Saharan Social Development Organization, Rural Africa Health Initiative, Women and Children Health Empowerment Foundation, Palladium, PI, Society for Family Health, TCI, ARFH, PLAN International and MNCH2.

In the course of extensive deliberations by participants at the workshop, the following were noted:

1. Health as a fundamental human right and the Federal and State government have a social compact to provide quality healthcare despite the provision of health care been on the concurrent list. Furthermore, all stakeholders in the health sector have the responsibility to provide support to Government and communities also have a responsibility for their own health.
2. Maternal, Newborn and Child Health indicators are pointers to any Nation’s progress and currently these indicators reflect the poor status of Maternal, Newborn, and Child Health in the country which is in Nigeria indeed a silent emergency with about 57, 000 women dying from during pregnancy and childbirth, 240,000 newborn die and 900,000 children under 5 die annually.
3. In addition, the coverage of key interventions to improve MNCH is low. For instance, the Skilled Birth Attendance rate is 38%, postnatal care for first 2 days 40% and Antenatal care by a skilled attendant 61%. This remains so despite the adoption of the National Policy on Human Resources for Health (HRH) in 2008 by the National Council on Health. Notwithstanding, many states have not yet adopted or adapted the framework to guide the planning and management of the workforce.
4. Human Resource for Health (HRH) is a key component of any health system and the critical issues affecting HRH in Nigeria are inadequacy as per WHO standard, poor skill mix, reduced competence, inappropriate and or unequal distribution, retention issues and restrictive HRH policies.
5. In 2014 Nigeria adopted the Task Shifting & Task Sharing Policy endorsed at the National Council on Health as one of the key strategies to address HRH shortages and a tool to be used to reach the sustainable development goals for MNCH. This policy has been implemented for 3 years and it is currently undergoing review to assess implementation and reflect emerging issues globally.
6. Evidence from the past 3 years of implementation reveal certain fundamental issues that have affected implementation of the policy thus far which include:
7. Poor dissemination and adoption of the TSSP by states.
8. Insufficient funds for scaling up implementation of TSSP
9. Lack of adequate ownership by states
10. No concrete plans at the National and State levels to train/employ adequate numbers of the regular cadres of health care workers (doctors, nurses/midwives, pharmacists)
11. The inadequate number of healthcare workers trained on the specific tasks to be shifted or shared.
12. TheInadequate compliance with stipulated tasks by the healthcare workers undertaking the tasks.
13. Disharmony among healthcare workers.
14. Lack of institutionalization of adequate, supervision, monitoring and evaluation.

In light of the observations, the meeting hereby made the following recommendations:

1.  There is the need for Government to provide responsive and accountable health services to the Nigerian people.
2.       NGOs and CSOs can support the Government to strengthen or create systems to ensure quality health service delivery.

 iii.      To achieve the above NGOs and CSOs have the following responsibility:

1. Advocate for Government at all levels to be accountable and provide funds as well as be held accountable for funds appropriated and spent.
2. Advocate for Government at all levels to train and employ the right mix of HRH and ensure their appropriate distribution.
3. Monitor implementation and ensure quality assurance.
4. Participate actively in the development and implementation of strategies and plans to improve MNCH at all levels of service delivery particularly at community level.
5. Support and engage people at the grassroots to demand quality health services.
6. Support the Strengthening of regulatory mechanisms at all levels of care.
7. Set up systems to monitor critical inputs into the health system in a bid to ensure transparency and improve the efficiency of service delivery as well as independent periodic evaluation of health programs.