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Lessons Learned from the Systematic Scale-Up of Family Planning Task-Shifting and Task-Sharing in Cross River State, Nigeria

Human resource shortages in the health services are widely recognized as a threat to the attainment of the health-related sustainable development goals (SDGs), including reduction of maternal mortality.

A more rational distribution of tasks and responsibilities among health worker cadres has the potential to improve accessibility and cost effectiveness within health systems and to mitigate the impact of the health worker shortage. Nigeria’s national TSTS policy, approved in 2014, allows CHEWs) to provide long-acting family planning methods, including implants, in addition to short-acting, non-clinical methods, thus helping to ease the burden on facility-based providers and increasing accessibility to more rural areas.

With technical support from the Evidence to Action (E2A) Project and Pathfinder International Nigeria, Cross River State (CRS) operationalized the National Family Planning (FP) Task-Shifting, Task-Sharing (TSTS) Policy through the Saving Mothers, Giving Life (SMGL) Initiative.

Through SMGL, Pathfinder and E2A trained community health extension workers (CHEWs) to provide contraceptive implants, conducted operations research to assess the feasibility of task-shifting the provision of implants to the community level in CRS and Kaduna state, and provided support to the CRS government to develop and implement a TSTS scale-up strategy. During the scale-up strategy development process, four pillars were identified as essential components of the innovation for the scale-up process: training, community mobilization, supportive supervision, and commodity security. Building on these pillars, since 2017, E2A and Pathfinder Nigeria have provided technical assistance to CRS stakeholders at the state and local government levels to implement the strategy for systematic scale-up of task-sharing family planning services-with a particular focus on implant provision.

Based on the collection of both qualitative and secondary quantitative data, this paper documents the experience of planning and managing the effort to operationalize and scale up the family planning task­-sharing/task-shifting policy in Cross River State from 2017 to 2018. The purpose of the report is to provide actionable information on how to improve task-shifting scale-up.


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