Task Shifting Task Sharing

Task Shifting Task Sharing

The Task-Shifting and Task-Sharing (TSTS) for Essential Health Care Services policy in Nigeria was approved in 2014. The TSTS policy presents an opportunity to increase access to FP commodities and services through the lower cadre of workers especially in underserved populations. However, to achieve this vision for increased access will require revision to the TSTS policy to enable Community pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) in Nigeria provide long acting reversible contraceptive (LARC) commodities through the private sector, the LARC also needs to be listed in the country’s treatment guidelines to enable the commodities to be stocked by CPs and PPMVs. The PAS project is working on TSTS advocacy for FP in Nigeria to allow CPs and PPMVs to be included in the provision of expanded FP services.

The TSTS component of the PAS project design was originally limited to Pharmaceutical Society of Nigeria’s (PSN) work in Kaduna and Lagos states and also support for the TSTS policy revision at National level (PAS Framework Primary Investment Outcomes 6 & 7). The TSTS component under the guidance of the foundation was however expanded from June 2018 to focus on four new states (Anambra, Enugu, Rivers and Taraba states). The following is a progress narrative on TSTS implementation in the states.

Expected Outcomes by End of Project.

The TSTS component aims to achieve 4 investment primary outcomes including the adoption and revision of TSTS policy in Anambra, Enugu, Rivers and Taraba states by project end.

2) Improve coordination of donor funded programs supporting government, CSOs and professional associations on programs concerning human resources for health, family planning , CKD and health financing im Anambra, Enugu , Rivers and Taraba states.

3) Strengthened (updated) national treatment guidelines ( NSTG, NEML and PPMV List ) to enable CPs and PPMVs deliver reversible FP commodities

4) Strengthened implementation of the revised national treatment guidelines at the State level using TSTS policy to enable CPs and PPMVs to deliver reversible FP commodities and implants in the medium term. There are 29 investment intermediate outcomes to achieving this and 47 investment outputs that culminates into the expected outcomes by the end of project.

Progress Narrative.

The TSTS policy has been revised reviewed and validated (19thNovember, 2018) but yet to be launched nationally for adoption in Anambra, Enugu, Rivers and Taraba states.

To investigate and understand the status of implementation of the previous TSTS policy (2014), four baseline studies on the status of Task Shifting Policy Adoption were carried out, one in each of the four states. Findings revealed that the TSTS policy (2014) was only adopted in Enugu state, but not fully operationalised unlike the other three states where the TSTS policy was neither adopted nor implemented. The survey findings were now compiled to develop issue briefs in the four states and develop advocacy asks.

PAS TSTS sub grantees in the four states proceeded to identify and assess CSOs and professional health associations working in the state on advocacy programs with particular regard to human resources for health and health financing.  The CSO presence with regards to advocacy programs working in human resources and health financing was strongest in Anambra state (36) with the rest having a sizeable presence (Enugu 18, Taraba 16 and Rivers 17). A coalition was built with PAS advocates SSDO, RAHI and WACHEF taking the lead and shared the findings of our baseline study on the TSTS policy implementation status in the Anambra, Enugu, Rivers and Taraba respectively.

PAS TSTS sub grantees armed with evidence from the baseline surveys held policy dialogues in the various states to engage with government and stakeholders on the TSTS policy. In all, four policy dialogues were held, one per state (Taraba with 30 attendees-August 8th-9th, 2018, Anambra with 19 attendees- August 24th, 2018, Enugu with 23 attendees- August 20th, 2018, Rivers with 35 attendees- August 24th, 2018). Technical working groups were formed. After which four policy briefs were developed on the TSTS policy. Three studies were conducted to determine the knowledge, attitude and commitments to TS study of participants in the policy dialogue. The results evidenced that there were improvements in their knowledge and understanding while the charted recommendations highlighted their commitments to TSTS in their states.

Two meetings on TS with CSOs and professional health associations to build their capacity held in Rivers (July 18th, 2018) and Taraba (August 22nd, 2018) states to build on the coalition and increase capacity of CSOs to advocate for TSTS policy following the policy dialogues. WACHEF and RAHI were recognized as leads in their states on this issue area and are forefront of the advocacy for the adoption and implementation of the policy. Four advocacy visits for the waiver done.

Waivers were gotten for Taraba, Enugu and Rivers states to train our pilot CPs and PPMVs.

To increase capacity of CPs and PPMVs as state level providers in the TSTS policy, a baseline study on the association of CPs and PPMVs in Taraba, Anambra, Enugu and Rivers States to determine their capacity and potential to be trained in an expanded FP service delivery program was conducted. The survey findings revealed that despite not having formal trainings, most of the CPs and PPMVs already carried out these expanded FP services. Irrespective of their training status they were unanimous in their support for a standardized training to be offered to CPs and PPMVs. This was justification for us to provide them with appropriate standardized trainings on long acting reversible contraceptive methods. Furthermore, a mapping of pre-service and in-service training institutions curriculum in Taraba and Rivers State to determine if the new teaching requirement of TS policy was being addressed and also for identification of training needs for TS to ensure sustainability of the trainings and eventual ownership by the states was done. The results revealed gaps in the training curriculum of the 2 training institutions in Taraba and 4 institutions in Rivers state.

To support the training of the pre service training institutions on new skills for TS, 25 master trainers were trained in collaborations with SFH (November 5th-7th, 2018), 10 from Taraba, 5 from Anambra, 5 from Enugu and 5 from Rivers state. These master trainers were then supported to conduct step down the trainings of our pilot groups of CPs and PPMVs in their states. An implementation work plan for this activity was drawn up. Pre and post analysis done during showed significant knowledge gain on LARC understanding, teaching and service delivery.

Service delivery projections.




CPs                       PPMVs

























Two M&E tools were designed to track service implementation as a result of TS training. A session was organized on the use and familiarization of the tool for ease of practice.

dRPC PAS provided technical assistance to Anambra state government (MOH) to strengthen the coordinating committees of TSTS. To support the TSTS adoption or adaption and implementation in the state, copies of the TSTS policy (2014 edition to be reviewed) were provided to the Anambra MOH, key stakeholders (the commissioner of health, the permanent secretary MOH, the director of public health and the director of nursing services Anambra state) were invited to the FMOH revised TSTS policy validation meeting in Abuja (November, 2018) to participate and be mentored on the process of adoption or adaption of the TSTS policy for Anambra state. Support was provided via SSDO PAS to set up Anambra state review committee and also inaugurate the committee to review the TSTS policy. An implementation plan was drawn up with the first and second review coming up next, followed by the launch of the TSTS policy for the state. The PAS project on TSTS adoption and implementation in Taraba, Anambra, Enugu and Rivers State has made significant progress.