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Task Sharing: Zambia and Kenya

Mother and twins in Zambia

Research Overview

TRAction’s sub-awardee Columbia University's Averting Maternal Death and Disability Program (AMDD) is utilizing case study methodology and landscape analysis to document the process of implementing task sharing to strengthen health system capacity and increase the provision of and access to life-saving emergency obstetric care (EmOC), particularly emergency Caesarean section. Partners from Chainama College of Health Sciences (Zambia) and Community Health Promotion Kenya conducted the in-country research. Through the Strengthening Human Resources in Partnership (SHaRP) project, a set of guidelines for national-level decision makers in countries seeking to implement task sharing as a means of increasing access to Caesarean sections will be developed and tested. SHaRP research efforts include a retrospective case study that is being conducted in Zambia, a developing country with recent experience with the transition to task sharing within the health system, and a landscape analysis desk review being conducted in Kenya.

Project Locations

Zambia and Kenya


Research Objectives

The ultimate aims of SHaRP are to: 1) develop, document, and disseminate the process of implementing task sharing as an evidence-based intervention; and 2) break down the task sharing implementation process into manageable parts for low-resource and high-need countries to be able to share lessons learned and take critical next steps in initiating task shifting to strengthen health system capacity and increase the provision of and access to life-saving emergency obstetric and neonatal care for women experiencing major complications during childbirth. The SHaRP initiative will foster collaboration between maternal health experts, clinicians, policy makers, and in-country task sharing implementation partners.

Graphic of the research design model

Lessons Learned


  1. Medical Licentiate Practitioners (MLPs) in Zambia are functioning effectively in health facilities, bringing quality life-saving care, including comprehensive emergency obstetric care (CEmOC), provided they have the necessary enabling environment.
  2. The work of MLPs is appreciated by colleagues at district and facility levels, and they are regarded as vital and motivated members of the health professional team.
  3. The role and interests of the MLPs are not well understood or represented at the national policy level, resulting in a range of decisions that have systematically undermined the cadre, including, amongst others, issues of legal protection, career advancement, and remuneration and funding support for training. These issues could ultimately threaten the long-term sustainability of the cadre.


  1. The role and interests of the Clinical Officers – Reproductive Health (CORHs) are not well understood or represented at national policy level resulting in a range of decisions that have systematically undermined the cadre – including amongst others issues of legal protection, career advancement, remuneration and funding support for training – and that ultimately these issues could threaten the long term sustainability of the cadre. The scope of practice for the CORH must be clearly defined in accordance with their training (thus including c/sections and other emergency obstetric surgeries) at a national level and communicated to all stakeholders.  Based on this scope of practice, legal protections for the CORH must be clarified for the CORH functioning in both public and private sectors. 
  2. The failure to integrate the CORH into facility staffing establishments and the lack of clarity regarding the roles and responsibilities of the CORH at facility level has led to ad hoc supervisory arrangements and feelings of resentments towards the CORH from other health professionals. To address this issue requires action at national and county level. The national and local levels must ensure that the CORH are appropriately posted to facilities where their skills can be fully utilized, and at facility level, superintendents need to clarify the lines of accountability, supervision and responsibility, to aver inter-professional tensions, and facilitate effective functioning.
  3. The CORHs are generally committed and motivated to practice the skills received during their training in order to improve the reproductive health of the population they serve, and reduce maternal mortality. Where they are able to practice effectively within a supportive environment they have been able to reduce excess referrals, and expand access to care.  In addition, much of the reproductive health care has been provided through the private sector. If access to reproductive health care, and in particular CEmOC is to be expanded through the public sector by the CORHs, more attention will be required to address issues of the CORH salary and career progression, in addition to ensuring that the appropriate drugs, equipment and infrastructure are available to support the provision of CEmOC. This will require that the status of the CORH specialization is appropriately recognized and remunerated above that of the general CO.


Dissemination of Findings

The SHaRP research project preliminary findings and methodology were shared in November 2013 in Malawi to the annual regional Africa Network of Associate Clinicians (ANAC) meeting. The meeting brought together 11 countries that have associate clinician cadres and the opportunity was used to share similar experiences and challenges like those found in the Zambia research.

AMDD, ANAC, and ACNM (American College of Nurse-Midwives) also participated on a panel at the Third Global Forum on Human Resources for Health held in Brazil in November 2013 discussing the SHaRP study in the context of associate clinicians worldwide. A representative from the East, Central, and Southern Africa Health Community (ECSA HC) also attended the Third Global Forum for Human Resources for Health, where she participated in the workshop-side event “Achieving Universal Health Coverage? Not Without Associate Clinicians. Time to Leverage North-South Partnerships.” Collaborating with ECSA-HC, Columbia AMDD drafted a guide for disseminating study findings and implementation of task sharing of Caesarean section deliveries.

A Stakeholder Dissemination Meeting was held in August 2014 in Lusaka, Zambia with key national stakeholders from the Ministry of Heath, Ministry of Community Development, Maternal and Child Health, Professional Associations and Councils representatives from international development partners and ECSA PI and research collaborators from Tanzania and Malawi.



In progress


Research Partners

Chainama College of Health Sciences (CCHS)
Community Health Promotion, Kenya (CHPK)
East, Central and Southern African Health Community (ECSA-HC)
Africa Network for Associate Clinicians (ANAC)
American College of Nurse-Midwives (ACNM)
Principal Investigator: Helen de Pinho

Project Status

Country / Countries: 
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