Sefako Makgatho Health Sciences University, South Africa
Sam Mndzebele is a Senior-Lecturer at Sefako Makgatho Health Sciences University, South Africa, School of Public Health. He has completed his graduation from the University of South Africa with a PhD in Public Health Research Studies. He has completed his graduation with a Bachelor of Education (BEd) from the University of Swaziland in 1998. In 2003 he has obtained both his Master’s degree and Postgraduate Diploma in Public Health under the Bristol Myers-Squibb Foundation.
The policy of task-shifting and decentralization of health services as perceived by health workers in Swaziland
Decentralization of public health services and task-shifting are two phenomena that have been formulated into policy and adopted in many countries in order to address critical public health challenges including human-resource shortages. The attempt through this is study was to add value on the policy of task-shifting and decentralization from the perspectives of health workers. An in-depth interview approach in which five Focus Group Discussions (FGDs) were conducted with 29 purposively selected health workers (mainly nurses). All the FGDs were recorded, transcribed and finally analyzed using the N-VIVO software. A total of seven thematic areas that were perceived by health workers on the concept of decentralization and task-shifting of health services were unveiled. It transpired that health workers relatively understood this health policy and that they regarded it as a positive development on the part of their communities and patients. They claimed that as a result of the policy on decentralization and task-shifting of health services, most healthcare services were now closer to the communities and that most recipients of healthcare services such as clients/patients no-longer wait in long queues to see healthcare providers in facilities. Health providers believe that now there are few chances of their clients/patients being lost to care and that there is improved service delivery in most healthcare facilities. On the other hand, the health workers perceive this policy as a challenge to the health sector in terms of its implementation coupled with inadequate resources such as material supplies, infrastructure, manpower-shortage and insufficient drugs. These findings suggest that there are a number of public health systems and policy issues that form a core of the experiences and perceptions of health workers in relation to the policy on decentralization and task-shifting of health services. According to health workers, these health systems and policy issues can be categorized as either positive or negative developments for the health sector.