– Task shifting: an approach to meeting the contraceptive needs of women in Burkina Faso

330 maternal deaths per 100,000 live births: women in Burkina Faso continue to pay a heavy price for motherhood. With a shortage of qualified health personnel to provide quality family planning services, the country also has a low contraceptive prevalence rate (15%) and a high rate of unmet need (24%)¹. Since 2010, Equipop has been promoting task delegation in Burkina Faso and has been involved for two years in the implementation of a pilot project in two districts of Burkina Faso.

What is task delegation?

Task shifting (TS) is a high-impact strategy for improving access to family planning (FP) that has been developing for some 30 years and is showing encouraging results. It is recognized by the WHO² as effective, safe, and acceptable in countries where the health system is limited in terms of both skilled human resources and service accessibility. In practical terms, it enables additional categories of health workers to provide FP services, through training, and thus to offer more women the contraceptive services they want.

Equipop's support for political and resource mobilization for the implementation of the DT

Since 2010, Equipop has been committed to promoting DT by advocating to the government and health decision-makers, alongside Burkinabe stakeholders convinced of the potential of this strategy to combat maternal mortality. It took four years for a protocol authorizing the testing of DT in Burkina Faso to be signed between the Ministry of Health and Equipop. In July 2015, following numerous consultations and a multi-stakeholder workshop, Burkina Faso adopted a national document and formalized a project to test the implementation of the delegation of certain FP tasks with the support of Equipop. The aim is to authorize, after training and under supervision, the administration of long-acting contraceptive methods (IUDs, implants) by frontline health workers (APL)³, which until now had been the sole responsibility of doctors, state nurses, and midwives, and the initial pill and injectables by community-based health workers (CBHWs).

A clear and ambitious goal: experimenting with DT in Burkina Faso

The pilot project (2016–2018) involved 17 health and social promotion centers in the Tougan health district and eight in the Dandé health district. Under the auspices of the Burkina Faso Ministry of Health, through the Directorate of Health and Family (DSF). It brought together a consortium of three organizations with specific responsibilities: MSI-BF for the training of frontline workers in the provision of long-acting methods in health training centers, ABBEF for the community component through the training of community-based health workers in the initiation of pills and the administration of injectables, including Sayana Press, and Equipop for the advocacy and capitalization component. Initial assessments show a sharp increase in the use of modern contraceptives, particularly among new users, including many young girls and women, and reveal no major incidents reported in the intervention areas.

Capitalizing on change processes to promote learning, quality, and scaling up

Focus groups, semi-structured interviews, mind maps, role-playing, analysis of professional practices... At each stage of the project and with each of the stakeholders (APL and ASBC, doctors, supervisors, and users), every effort was made to encourage discussion and exchange, but also to transform these spaces into veritable knowledge factories. " With the Equipop workshops, I learn from the experiences of others, and it also helps me remember things from the training that I had forgotten. " (APL, 2017).

The capitalization system set up to collect and analyze the experience of stakeholders has facilitated continuous learning, identified best practices, and highlighted efforts that need to be continued to ensure quality services. " I have complete mastery of the clinical procedures for inserting intrauterine devices and implants," says one APL.

On the ASBC side, progress has been highlighted in the area of counseling. "Before, I didn't know much about the stages of counseling, but with the Task Delegation project, I've learned a lot." 

Finally, confidentiality is a shared concern and is guaranteed by this ASBC: "Even if the lady's husband came to ask me what we had talked about, I would use the same ruse as the APLs in health centers." 

In addition to being able to offer more high-quality FP services, agents have developed strategies to help create an FP-friendly environment by finding solutions to complex situations.

I had received a husband who was angry after his wife had an implant inserted. So I called on the ASBC in the village where he lived, which mobilized a resource person from the village, and together they managed to convince the husband. APL, 2017