Marie Stopes International successfully provides and increases access to long-acting reversible contraceptives and permanent methods of family planning through task sharing to lower level providers in Uganda and in other country programmes.Task sharing is now widely acknowledged as a key strategy for addressing the critical shortage of health providers that affects healthcare in many low income and rural areas. In Uganda, 34% of married women have an unmet need for family planning services, including 14% who do not wish to have any more children. The country is experiencing a serious shortage of trained health providers, and this affects the number of providers who can offer long-acting reversible contraceptives and permanent methods of contraception, especially in rural areas.
The Ministry of Health in Uganda requested locally generated evidence to determine whether trained clinical officers (qualified mid-level health practitioners in Africa) can provide tubal ligations (female sterilisation). To test this, Marie Stopes Uganda conducted a study among four trained clinical officers in mobile outreach teams in rural regions of Uganda to determine if task sharing of tubal ligations to clinical officers is safe and acceptable to women.
The observational study was conducted between March and June 2012, and assessed complications during and after the tubal ligation procedure, as well as the acceptability of the procedure performed by trained clinical officers. A total of 518 women were recruited to take part in the study. They were then followed up three, seven and 45 days after the procedure. Nearly all women who had the procedure reported having either a good or very good experience and would recommend the health services to a friend.
Using this evidence, Marie Stopes Uganda has successfully advocated for permission that trained and supervised clinical officers at private not-for-profits organisations can provide safe and acceptable tubal ligations and also that a roll-out plan of training of tubal ligations for public clinical officers in five districts of Uganda will be developed.