Experts call for urgent policy action to strengthen task-shifting, maternal healthcare

Stakeholders have called for renewed political commitment, stronger workforce investment, and clearer policy direction to address task shifting and strengthen maternal healthcare delivery across Nigeria’s primary healthcare system.

The call followed revelations that more than half of trained health workers in many primary health centres (PHCs) operate as unsalaried volunteers, a situation stakeholders say contributes to weakened service delivery and poorer health outcomes.

Experts at the Task Shifting Symposium 2025, held in Abuja on Tuesday, said task shifting remains necessary but must be urgently strengthened through better training, supervision, and sustainable government funding.

The symposium, themed “The Policy and Practice of Task-shifting for Maternal Healthcare Services in Nigeria’s Primary Healthcare System”, examined persistent human resource gaps and the reforms required to reduce maternal deaths.

It brought together policymakers, researchers, and frontline healthcare workers who agreed that Nigeria’s maternal mortality crisis cannot be resolved without deliberate efforts to expand and support the PHC workforce.

Mandate Secretary of the Federal Capital Territory Administration (FCTA) Health Services and Environment Secretariat, Dr Adedolapo Fasawe, while delivering the keynote address, said discussions at the event underscored the national urgency to scale up capacity and deploy task shifting more effectively across PHC facilities.

“This is resonating, not just for the FCC, but for the entire nation as well. Task shifting has been known to be a very terrible tool in achieving efficient, impactful, and productive services, only when done right. With clear boundaries, guardians, training, retraining, and supervision, this task-shifting symposium is an eye-opener.”

Fasawe said Nigeria’s human resource crisis in health makes it critical to equip lower-cadre workers with the skills to support overstretched professionals.

“We have a lot of talented people, especially in this aperture, who, when trained well, can easily step into the shoes of senior professionals and do it equally as well,” she said.

She reaffirmed the FCT’s commitment to reducing preventable maternal and child deaths, saying, “We have zero tolerance for maternal mortality or infant or neonatal mortality in the FCC. We always say there’s no reason for a woman to die while bringing life into the world.”

According to Dr. Francis Ayomoh, honorary postdoctoral researcher at the University of Oxford and convener of the symposium, the study on the policy and practice of task shifting for maternal healthcare services in Nigeria examined both national and FCT-level realities to better understand the daily challenges faced by PHC workers.

Ayomoh noted that Nigeria remains one of the world’s highest contributors to maternal deaths and that severe workforce shortages make task shifting unavoidable.

Noting that the 202 and 2023 were instructive, he said, “The findings suggest that at least 50 per cent of primary healthcare workers in the FCT are unpaid volunteers who rely on facility stipends rather than government salaries.

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“This precarious situation requires urgent attention, which is why one of my key recommendations is increased government funding to employ more primary healthcare workers

“It is no news that we have a severe health workforce shortage. This is why task shifting was necessary. But the study we conducted has shed more light on what the issues are with task shifting,” he noted.

He explained that the major challenge is balancing access and quality, saying, “We cannot do without task shifting because of the level of human resource gap we have.

“However, it is important that we reflect on the policy dilemma of balancing increasing access to maternal health services with the need for optimal quality.”

A key finding of the study, he said, is the need for stronger government action in employing trained but unpaid PHC workers.

“Studies show that we still have some lower-level healthcare workers, like community health workers, nurses, midwives, who are available to be employed but are still not put on the payroll and are working under very precarious conditions as volunteers. Let’s employ as many as the government can afford to pay.”

The researcher also called for continuous training, supportive supervision, and a renewed focus on patient-centred care.