Implementing a Task Shifting Programme in Maternal and Neonatal Health in Liberia: Insights From Policymakers and Frontline Health Workers

<title>Abstract</title> <p>Background Sub-Saharan Africa bears the world’s highest burden of maternal and neonatal mortality, compounded by critical shortages of skilled health workers. Task shifting has been promoted by the World Health Organisation as a strategy to address health workforce gaps. In Liberia, since 2012, the NGO Maternal and Child Health Advocacy International (MCAI) has been implementing a task shifting programme to train midwives and nurses as obstetric and neonatal clinicians to help address a shortage of medical doctors in maternal and neonatal health in rural facilities. This study, embedded within the Oxford Maternal and Neonatal Health project, explored the perceived benefits of the programme for maternal and neonatal health and the challenges of integrating the programme into Liberia’s healthcare system. Methods This qualitative study involved primary data collection through seven key informant interviews (KIIs) conducted in 2024 with policymakers, health workers, and an MCAI representative, as well as the secondary analysis of 11 transcripts from KIIs conducted in 2020. Data were analysed thematically using the framework approach with NVIVO 14.0, and coding by two researchers was done to enhance reliability. Ethical approval was obtained from OxTREC (Ref. 529 − 20) and Liberia’s ACRE-IRB (Protocol #20-06-217). Results Participants reported that the MCAI programme enhanced responsiveness to maternal and neonatal emergencies and optimised workforce efficiency by reducing doctors’ workload. However, several systemic challenges were identified as barriers to integration and sustainability. These include inter-cadre resistance from physicians, the lack of incorporation into accredited training institutions, unresolved licensing and regulatory frameworks, and reliance on donor funding. Conclusion The MCAI programme and task shifting were, for the most part, viewed positively by policymakers and frontline providers; however, political, governance and financial issues are impacting the sustainability of the approach. Although recent developments indicate that some reforms in licensing and training have emerged, the findings highlight both the promise and fragility of implementing a task shifting programme in Liberia.</p>