Table 5 Selected participants’ opinions on task-shifting community-based MDR-TB care to CTSs

Task-shifting is good for the patient especially those too ill or do not have transport money to travel daily to the clinic for injections. I see task-shifting of injection administration to patients’ neighbours as an important part of the so-called patient-centred care. [Participant C]

Instead of letting nurses continue throwing their roles to lay people, we should train more professional healthcare workers and ensure they don’t leave for greener pastures. [Participant F]

Most patients stay in villages that are difficult to reach with cars. With proper training, CTSs are the only people able to reach these patients. Otherwise rural patients will not get MDR-TB treatment at all. The just need proper guidelines and tools prepared in SiSwati (local language). [Participant D]

The use of lay people to give injections is unethical but it is better than nothing. Do you think you can train CTSs to respect the confidentiality of the patient’s medical problems in three days? Giving injections involves exposing and sometimes seeing the intimate anatomy of patients. This takes place in a home setting where there is no privacy. Let us adopt task-shifting, but at the same time, we should address the root causes for shortages in nurses. [Participant B]

The delegation of tasks to community health workers is working in HIV. Of course, to use lay people to provide injections is complicated. So the MOH should speed-up the process of putting together a comprehensive policy to guide the use of LHWs. [Participant H]

Task-shifting is the only solution though. But I still want to have a look at the curricula for training CTSs. I am convinced it’s unsafe for the patients to receive injections from people other than nurses. Very soon patients will think they are receiving second-class care from CTSs. [Participant A]

An adequate number of healthcare workers will always be scarce even if we build nursing schools in every region. The increase in MDR-TB cases makes the situation worse. However, task-shifting to CTSs in Shiselweni improved treatment adherence and MDR-TB treatment cure rates that are important in achieving targets set by the country, WHO and SDGs. [Participant I]

In the short-term, we can use task-shifting. Is this approach a magic bullet for problems in our healthcare system? No! To me, this is just a half-baked hurried solution for the poor. A few things need to be done before scaling-up the use of CTSs to provide MDR-TB treatment. Besides, in case of a complication arising from poor injection practice by a CTS, how will the liability be adjudged? Is it the CTS, the trainer, the implementing organisation or the MOH that is liable? Is the training effective enough to teach CTSs infection prevention and safe handling of injections? [Participant J]