Knowledge, Attitude and Practices regarding task shifting of eye care services in Kenya
Date
2020-12
Authors
Ollando, Ernest Agola
Journal Title
Journal ISSN
Volume Title
Publisher
Strathmore University
Abstract
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.
Description
A Thesis submitted in partial fulfillment of the requirements for the Degree of Master of Business Administration in Healthcare Management at Strathmore Business School
Keywords
Task shifting, Ophthalmologists, Non-physician Cataract Surgeons