Abstract
Background: Task-shifting in primary healthcare was an initiative long adopted by the Federal Ministry of Health to assist in ensuring human resource maximization for universal health coverage especially across domains of reproductive, maternal, child health, family planning, and high prevalence communicable illness like tuberculosis and malaria. Despite its potential, only some states have adopted and begun implementation of the strategy, and among states that have adopted it like Edo State, the necessary assessment to understand the implementation level, acceptance, integration status and concerns of health workers about it locally, is limited. Aim: This study assessed the knowledge, perception and barriers to task-shifting among primary healthcare workers in Benin-City. Methods: A descriptive cross-sectional study was conducted among 120 healthcare workers selected using a multistage sampling technique. Data were collected using a structured, self and interviewer administered questionnaire covering socio-demographic characteristics, knowledge, perception, barriers and enablers to task-shifting. Data were analysed using SPSS version 27.0. Univariate analysis summarised means, frequencies, and percentages. Bivariate analysis using chi square tests determined associations between socio-demographic factors and respondents’ knowledge and perception. Binary logistic regression identified independent determinants of good knowledge and perception. Statistical significance was set at p < 0.05. Results: A total of 120 respondents participated, with a mean age of 35.9 ± 8.6 years, with females being 112 (93.3%), males 8 (6.7%). Those who demonstrated good knowledge were 37 (30.8%), and those with poor knowledge 83 (69.2%). Receiving training on task-shifting was found to be statistically significant and associated with knowledge, as those with prior training had good knowledge (59.9%) record than those without (17%) (χ²: 21.455; p < 0.001). Perception of task-shifting was mixed, as good and poor perception were almost equally distributed at 59 (49.2%) and 61 (50.8%) respectively. Age was significantly associated with perception, and was also a significant predictor of knowledge, with increasing age associated with reduced likelihood of positive perception (OR = 0.927; p = 0.024). Workers with 5 – 9 years of experience were also less likely to have positive perception of task-shifting (OR = 0.165, 95% CI: 0.031–0.872, p = 0.034). The barriers to task-shifting encountered most by respondents were inadequate training and knowledge gaps (mean score: 3.99 ± 1.19), lack of clear job description or role boundary (3.74 ± 1.28), inadequate supervision or monitoring (3.64 ± 1.28), lack of incentives or recognition (3.54 ± 1.33), resistance from higher cadres, shortage of staff and related issues were also mentioned as challenges/barriers. The enablers reported were adequate training, and supportive supervision (3.90 ± 1.42), availability of clear policy guideline (3.93 ± 1.42), teamwork and collaboration among cadres (3.77 ± 1.41), support from management and policy makers (3.79 ± 1.41). Conclusion: Primary healthcare workers in Benin-City had predominantly poor knowledge of task-shifting and the national task-shifting policy, coupled with mixed perception of task-shifting. Inadequate knowledge or training among staff, lack of clear job descriptions or roles, inadequate supervision or mentoring, lack of incentives or recognition were the identified barriers, while adequate training and supportive supervision, provision of policy guidelines, teamwork and inter-cadre collaboration, and support from management and policy makers were named among enablers. There should be concerted efforts to improve knowledge and perception of task- shifting through training and adequate supervision provision; this will also remove barriers to task-shifting.
