Task sharing in family planning: Four easy actions you can take to help the health worker shortage

Family Planning Workforce

Kirsten Krueger, MSW

FHI 360 | Technical Advisor, Research Utilization

John Stanback, PhD

FHI 360 | Senior Scientist, Health Services Division

To me, [community health workers] are very helpful because in most cases I am busy. They have taken over that heavy work. You see, family planning needs a lot of talking to clients and yet I am always busy at the unit with deliveries, antenatal, immunization and many others. So with them I get helped. They have really taken off a big burden from me. 

~Achieng Rose, Midwife, Bulumbi Health Clinic, Busia, Uganda

Global health worker crisis

© 2013 Todd Shapera, Courtesy of Photoshare

Community Health Worker Marie Chantal walks into her village of Batamuliza Hururiro, near Rukumo Health Center, Rwanda. © 2013 Todd Shapera, Courtesy of Photoshare

Right now, we are 7.2 million health workers short of meeting the global population’s health care needs. By 2035, that shortage will reach 12.8 million. Twenty-nine of the 46 sub-Saharan countries are below the World Health Organization’s (WHO) lowest category of 2.5 doctors per 10,000 individuals. Moreover, medical providers are unevenly distributed; in most low-resource countries, doctors and nurses typically live and practice in urban areas, yet the majority of the populations in those countries reside in rural areas. Family planning services, in particular, suffer from grossly inadequate numbers of providers to meet the needs. A 2012 Guttmacher Institute estimate calculated 222 million women with an unmet need for modern contraception in low-resource countries.

The task sharing solution

Task sharing is the systematic delegation of tasks, where appropriate, to less specialized workers in order to maximize the efficient use of resources. It is now widely recognized as a key solution to the global health worker shortage, particularly in high-burden nations where the physician- and facility-centered models of health care delivery are simply not a reality. As reported recently in The Guardian, the director general of WHO, Margaret Chan, calls task shifting "the vanguard for the renaissance of primary health care."

Task sharing for family planning services is widely accepted within global health and development communities. The growing body of global evidence suggests it is a safe and effective way to expand access to family planning. While the practice is not without challenges and unanswered questions, using task shifting to increase access to and use of family planning services is increasingly endorsed by global health experts and normative bodies, including WHO.  Task sharing is also unequivocally called for in the groundbreaking FP2020 global effort which seeks to ensure access to family planning for 120 million additional women and girls by 2020.

How to help

There are countless actions that can help task sharing in family planning become more widely adopted and supported across the globe. Here are some suggestions to get started:

1. Know the latest WHO recommendations.

Summary of 2012 WHO Recommendation on Task Sharing

The information in this table indicates that a number of contraceptive methods can be safely and effectively delivered by mid- or lower-cadre health workers. 

A summary of the 2012 WHO recommendations on task sharing can be found here and includes the following table. The information in this table indicates that a number of contraceptive methods can be safely and effectively delivered by mid- or lower-cadre health workers.

2. Know the family planning policy in the country where you work, and advocate for evidence-based policies that endorse task sharing.

Country-level task sharing initiatives must be aligned with national health systems and policies that indicate what each cadre can do. If policies prohibit recommended task sharing, advocate for change. The new interactive Community Health Systems Catalog developed by Advancing Partners and Communities provides a snapshot of twenty USAID priority countries’ community health program structures, government policies, and the cadre(s) of community health workers and the services they provide.

3.  Consider lessons and experience that could be applied in your programs.

Here are several short illustrations to absorb and examine further:

  • Ethiopia is a dramatic national example of family planning services integrated into a community health program. The heath extension worker cadre who provide pills, condoms, and injectables from health posts and doorstep services are credited with a doubling of the country’s contraceptive prevalence rate between 2005-2011. Health extension workers are also now inserting Implanon implants.[1]
  • Malawi’s national standards and guidelines were changed to allow trained clinical officers (not doctors as is customary) to perform female sterilization. Ten percent of married women in Malawi rely on sterilization compared with less than two percent across Africa.[2] Also, nurses are allowed to provide implants and IUDs, and Health Surveillance Assistants, the lowest-level paid cadre in the MOH system, can provide injectables. [3]
  • Rwanda saw a five-fold increase in injectables use from 2005 – 2010 (5 percent to 27 percent) with the national transfer of family planning services to lower-level cadres and overall strengthening and expansion of health systems and delivery approaches.[4]
  • Bangladesh’s trained and supported Blue Star drug-shop staff safely provide injectable contraceptives and other quality family planning services, and many clients indicate a preference for using the drug shops. [5]
  • Zambia uses dedicated providers/midwives to provide implants and IUDs in public-sector facilities. A 2009 study revealed that more than 30,000 women opted to use long-acting reversible contraception over a 14-month period as a result of having the dedicated provider.[6]

4. Share what you know

The long-term success of task-sharing initiatives depends on political and financial commitments. Use your voice and networks to bring awareness, support, and influence for task sharing in family planning as a necessary strategy for addressing the urgent need and achieving global commitments.  Check out the K4Health Family Planning Advocacy Toolkit for information and tools for advocates at all levels and the K4health Family Planning Workforce topics page for more on strategies to mitigate challenges to the health workforce.

[1] PROGRESS Three Successful Sub-Saharan Africa Family Planning Programs. 2012. http://www.fhi360.org/sites/default/files/media/documents/3-successful-family-planing-programs-africa.pdf

[2] Jacobstein. Lessons from the Recent Rise in Use of Female Sterilization in Malawi. Studies in Family Planning 44(1) March 2013

[3] PROGRESS Three Successful Sub-Saharan Africa Family Planning Programs. 2012.

[4] PROGRESS Three Successful Sub-Saharan Africa Family Planning Programs. 2012.

[5] High-Impact Practices in Family Planning (HIP). Drug Shops and Pharmacies: Sources for family planning commodities and information. Washington, DC: USAID; 2013 Jun.

[6] J. Neukom et al. Dedicated providers of long-acting reversible contraception: new approach in Zambia. Contraception 83 (2011) 447–452 449