Knowledge, Attitude and Practices regarding task shifting of eye care services in Kenya

Ollando, Ernest Agola
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Strathmore University
Task shifting is a practice whereby tasks are delegated, where possible, to staff with shorter trainings and fewer qualifications, often to address human resource shortages. Kenya, like many Sub Sahara African countries, has a shortage of Ophthalmologists, with only about 132 serving a population of almost 48 million. The main objective of this study was to establish the knowledge, attitude and practices of Ophthalmologists and Non-physician Cataract Surgeons (NPCS) in Kenya, regarding task shifting of eye care services. Four subsidiary objectives that guided this study were: to determine the knowledge of Ophthalmologists and NPCS in Kenya regarding task shifting of eye care services, to determine the attitude of Ophthalmologists and NPCS in Kenya regarding task shifting of eye care services, to determine the practices of Ophthalmologists and NPCS in Kenya regarding task shifting of eye care services and to determine the role of task shifting, its merits, demerits, critical success factors as well as duration over which task shifting should be utilized in Kenya. The Theoretical framework used in this study was Principal-Agent Theory. For this study a mixed-methods approach was employed, involving a survey and key informant interviews. A pre-tested, structured online questionnaire was sent to 267 prospective participants via email or whatsApp. A response rate of 60.3% was achieved, with 161 out of 267 prospective participants returning the questionnaire. A total of 32 key informant interviews were conducted via telephone with purposively selected participants from both groups. Quantitative data was analyzed using SPSS version 23 to generate proportions, frequencies, and percentages. Results were presented in form of graphs, pie-charts and tables. For the qualitative study, interview recordings were transcribed into a text program following which the qualitative data was analyzed using Nvivo version 11. The findings of the quantitative and qualitative methods were integrated during the interpretation/ discussion phase of the study, following a sequential explanatory model. Majority of the participants understood what task shifting is; deemed it as necessary and affirmed that they delegated some tasks to other cadres in the course of their day to day Ophthalmic practice. Medical task shifting was acceptable to majority of the respondents, as was surgical task shifting. There was concern about Optical task shifting owing mainly to erroneous prescription of spectacles by some NPCS. Majority of the workplaces did not have Policies and Guidelines to inform task shifting practices. Almost all the key informants agreed that task shifting had a role in Ophthalmology in Kenya. A number of benefits were cited by participants, including cost savings, improved access to care, equitable distribution of eye health workers, improved quality of care amongst others. Several challenges were also mentioned by participants, including: unregulated task shifting environment, unclear scope of practice, lack of a legal framework for task shifting amongst others. Participants in this study knew about task shifting, deemed it as necessary and thought it should be practiced for as long as there’s a shortage of Ophthalmologists in the country. Several benefits were brought forth by the participants, but there were also several significant challenges that ought to be addressed by the decision makers, going forward. Attention should be paid to training and deploying enough Ophthalmologists to cover the whole republic in the long term.
A Thesis submitted in partial fulfillment of the requirements for the Degree of Master of Business Administration in Healthcare Management at Strathmore Business School
Task shifting, Ophthalmologists, Non-physician Cataract Surgeons