Task Shifting and Safe Surgical Care in Rural Adamawa, Cameroon: A Cross-Sectional Provider Survey
Study Summary
A provider-level assessment of task shifting, surgical and anaesthesia workforce support, safety concerns and capacity-building priorities in rural Adamawa Region, Cameroon.
Safe surgical and anaesthesia care is essential for universal health coverage, yet rural sub-Saharan hospitals depend heavily on non-specialist providers. This study assessed task-shifting practices, safety concerns and capacity-building priorities among perioperative providers in Cameroon’s Adamawa Region.
A descriptive cross-sectional survey was conducted among 20 surgical and anaesthesia providers from district and regional hospitals. Continuous variables were summarised using mean, standard deviation, median and range, while categorical variables were reported as frequencies and percentages. Exact binomial 95% confidence intervals were calculated for selected indicators.
Mean participant age was 42.1 years and 80% worked in district hospitals. Sixty-five percent reported performing specialist-level responsibilities. Although 60% reported formal task-shifting training, only 30% considered themselves adequately trained. Forty-five percent had formally defined scopes of practice and 45% received regular supervision. Seventy percent reported having witnessed adverse events associated with task-shifted care, while only 25% reported clearly defined referral pathways.
Task shifting was common and perceived to improve access, but was incompletely supported by training, supervision, equipment and referral systems. The findings support structured task sharing built around competency-based training, ongoing mentorship and verified patient-outcome monitoring.
Frontline Surgical & Anaesthesia Workforce
The study describes reported practice patterns among a small exploratory sample of perioperative healthcare providers working across district and regional hospital services in Adamawa.
Complete surgical and anaesthesia provider questionnaires analysed.
Sixteen of the 20 surveyed providers worked in district hospitals.
Mean participant age was 42.1 years, SD 8.4.
Mean duration of clinical practice was 10.2 years, SD 4.7.
Descriptive Cross-Sectional Provider Survey
The analysis was designed to establish a provider-level baseline of reported practices, perceptions and priorities rather than to estimate population-level prevalence or patient outcomes.
Cross-Sectional Survey
A structured questionnaire was used to assess existing surgical and anaesthesia task-shifting practices in Adamawa Region.
20 Providers
Every complete questionnaire contained in the supplied analysed dataset was included.
Descriptive Statistics
Means, standard deviations, medians, ranges, frequencies and percentages were reported, with exact binomial 95% confidence intervals for selected indicators.
Donabedian Model
The study was conceived around the relationship between health-system structure, processes of care and patient outcomes.
A Multidisciplinary Rural Perioperative Workforce
Participants represented the range of professional cadres involved in day-to-day surgical and anaesthesia service delivery.
16 of 20 respondents worked in district hospitals
The surveyed group reflects a setting in which district-level teams carry substantial responsibility for essential surgical, obstetric, anaesthesia and emergency services.
6 of 20 respondents.
4 of 20 respondents.
3 of 20 respondents.
3 of 20 respondents.
Breadth of Essential Surgical Care
Respondents reported involvement across obstetric, general surgical, anaesthesia, emergency and trauma care. Procedure questions allowed multiple responses.
Caesarean Section
17 of 20 providers reported involvement.
Anaesthesia for Surgery
14 of 20 providers reported involvement.
Minor Surgical Procedures
13 of 20 providers reported involvement.
Laparotomy
12 of 20 providers reported involvement.
Hernia Repair
12 of 20 providers reported involvement.
Trauma Surgery
11 of 20 providers reported involvement.
Specialist-Level Responsibilities Are Common
Thirteen respondents reported performing responsibilities normally undertaken by specialist personnel.
95% CI 40.8–84.6
13 of 20 providers reported task-shifted responsibilities
The activities reported by these 13 providers spanned anaesthesia administration, surgical procedures, preoperative assessment, postoperative management and emergency clinical decision-making.
Training Exposure Does Not Necessarily Equal Readiness
A central finding was the gap between receiving formal training and providers’ perceptions of whether that training adequately prepared them for task-shifted responsibilities.
12 of 20 reported having received formal task-shifting training.
Only six providers considered their preparation adequate.
Nine respondents reported that their scope of practice was formally defined.
Nine providers reported receiving regular supervision.
The study supports competency-based preparation, clear scopes of practice, defined escalation criteria and continuing clinical supervision rather than informal delegation driven solely by workforce scarcity.
Provider-Reported Safety Concerns Require Further Evaluation
Safety indicators reveal important areas for health-system strengthening while requiring careful interpretation because the study did not independently verify clinical events.
14 of 20 providers reported witnessing adverse events related to task-shifted care. Exact 95% CI: 45.7–88.1.
17 of 20 reported that complications were routinely documented. Exact 95% CI: 62.1–96.8.
14 of 20 agreed or strongly agreed that task shifting had improved access to surgical care. Exact 95% CI: 45.7–88.1.
The study did not contain patient records, perioperative mortality, verified complication rates or facility-level outcome data. Accordingly, these findings identify a safety signal requiring prospective monitoring rather than establishing that task shifting caused adverse clinical outcomes.
Safety Depends on the System Around the Provider
Respondents identified multiple structural and process barriers. These were multiple-response questions, so percentages are not intended to sum to 100%.
Referral Was the Clearest Structural Weakness
Task sharing is safest when clinicians can recognise the limits of local care and reliably escalate complex patients to an appropriate receiving facility.
95% CI 8.7–49.1
Only 5 of 20 providers reported clear pathways for complex cases
The findings point to a system in which task shifting may expand local access while referral transport, cost, communication and decision-making limitations constrain safe escalation when more advanced care is required.
Task Shifting Is Perceived to Expand Access
Agreed or strongly agreed that task shifting improved access
This finding illustrates the central health-system tension identified by the study: task shifting can help maintain essential surgical and anaesthesia services in areas with specialist shortages, while the quality and safety of that care depend on the strength of training, supervision, equipment, governance and referral systems surrounding the provider.
Providers Prioritised Supervision Above Training Alone
Respondents selected up to three interventions that they believed would most improve safety within their facilities.
Regular supervision and mentorship
Improved equipment supply
Strengthened referral systems
Structured training programmes
Clear clinical guidelines
From Informal Task Shifting to Structured Task Sharing
The study’s findings align with a systems approach in which workforce redistribution must be supported by organisational structures and safe clinical processes.
Workforce · Equipment · Referral
Competent staffing must be accompanied by functional equipment, essential supplies, transport, communication and receiving-facility capacity.
Training · Supervision · Governance
Defined responsibilities, competency assessment, checklist use, clinical documentation, mentorship and escalation protocols support safer task sharing.
Verified Patient-Level Monitoring
Prospective studies should measure complications, perioperative mortality, surgical volume, referral delays and patient-reported outcomes rather than relying solely on provider perception.
Practice, Education, Management & Policy
The study identifies practical actions that extend beyond additional courses or redistribution of clinical duties.
Define Safe Scope
Establish written responsibilities, procedure limits, escalation criteria, consistent safety processes, complication documentation and routine case review.
Competency-Based Training
Training should include supervised practice, competency assessment, refresher education and continuing mentorship rather than relying on attendance certificates alone.
Improve Facility Readiness
Priorities include essential equipment, oxygen, sterilisation, instruments, blood access, infection prevention and practical referral planning.
Formalise Task Sharing
Regional and national surgical plans should incorporate defined responsibilities, supervision standards, continuing professional development and quality indicators.
Interpreting an Exploratory Provider Survey
The study provides useful local baseline evidence but its results should remain within the boundaries of the data collected.
Small Exploratory Cohort
The sample comprised 20 providers and the number of eligible providers approached was not recorded, so a response rate and population representativeness cannot be established.
Recall & Social-Desirability Bias
Survey responses reflect provider-reported experience and perceptions rather than independently observed clinical practice.
No Unique Facility Identifiers
The dataset recorded facility level but did not retain unique facility identifiers suitable for inter-facility comparisons.
No Patient-Level Outcome Data
Patient records, perioperative mortality, verified complication rates and referral-delay durations were not included.
Safety Signal, Not Event Rate
The witnessed-adverse-event finding represents provider perception and should not be interpreted as a measured incidence of harm.
Patterns Within the Surveyed Group
Findings should not be interpreted as prevalence estimates for all providers or facilities across Adamawa Region.
Structured Task Sharing Rather Than Unsupported Redistribution
Task shifting is a common and, from the surveyed providers’ perspective, access-enhancing feature of surgical and anaesthesia care in rural Adamawa. However, fewer than one in three respondents felt adequately trained, fewer than half reported defined scopes of practice or regular supervision, safety concerns were common and referral pathways were frequently unclear. The findings support formalised task sharing with competency-based training, continuing mentorship, functional equipment, consistent safety processes, dependable referral systems and subsequent evaluation using verified patient outcomes.
Ethical Review & Participant Protection
Kesmonds Institute of Research and Innovation
Ethical review and approval were obtained from the
Kesmonds Institute of Research and Innovation,
Department of Research Publications and Internships, Cameroon,
under the Kesmonds International Research Institute Cameroon,
one of the bodies responsible for research approval in the Adamawa
Region of Cameroon.
Approval Reference:
0041022/SG/KIU
Participation was voluntary and based on written informed consent.
The analysed dataset contained de-identified participant codes rather
than names or direct identifiers. Appropriate administrative
authorisations were obtained before participant recruitment.
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Original Research
Descriptive cross-sectional provider survey examining surgical and anaesthesia task shifting, safety concerns and capacity-building priorities in Adamawa Region, Cameroon.
20 Perioperative Providers
The analysed dataset contained 20 complete questionnaires from healthcare providers routinely involved in surgical or anaesthesia care.
R Version 4.3.1
Continuous and categorical variables were analysed descriptively. Exact binomial 95% confidence intervals were reported for selected single-response indicators.
Donabedian Structure–Process–Outcome Model
The study considered health-system conditions, processes of care and the need for verified outcome monitoring when evaluating task-sharing arrangements.
Reference 0041022/SG/KIU
Ethical approval was obtained from the Kesmonds Institute of Research and Innovation, Department of Research Publications and Internships, Cameroon, under the Kesmonds International Research Institute Cameroon.
George & Dessalegn
P. M. George:
study conception and design, data collection, analysis and manuscript drafting.
M. Dessalegn:
supervision, study design, interpretation and critical revision.
Both authors approved the final manuscript.
Conflict of Interest & Funding
Conflict of Interest:
No conflict of interests.
Funding:
No funding received.
Editorial Timeline
CC BY 4.0
Published under the Creative Commons Attribution 4.0 International
licence.
DOI: 10.64573/torgj2608004
Volume 2 · Issue 3 · September 2026
The Operating Room Global Journal (TORGJ).
ISSN 3105-3262.
Original Research.
DOI: 10.64573/torgj2608004.
TORG Global Research Fellowship Programme
The manuscript acknowledges The Operating Room Global (TORG) Global Research Fellowship Programme for academic support.
Access the Published Article
Read the corrected full publication PDF or open the persistent DOI record.