Implementation of a paraprofessional role across the public health sector in Manitoba: Impacts on system capacity.

Abstract

Setting: Manitoba experiences sexually transmitted and blood-borne infection (STBBI) incidence rates above the national average and fundamental public health sector responses face human resource constraints.

Intervention: Manitoba implemented a paraprofessional role, the Communicable Disease Technician (CD Tech), to complete low-complexity STBBI investigations and support STBBI testing, care engagement initiatives, provider reporting, harm reduction supply distribution, and community engagement. Secondary roles included tuberculosis directly observed treatment (DOT) and virtual DOT, and flu and COVID immunization support. Twenty CD Tech positions were allocated to regional public health teams along with additional Public Health Nurse (PHN) positions to support the role.

Outcomes: Mixed methods were used to evaluate the impact on public health system capacity. Follow-up of chlamydia and gonorrhea case investigations increased from 35% to 98%. Volume of contacts followed by public health increased for chlamydia (114%), gonorrhea (33%), and HIV (68%). Health care provider reporting for cases of STBBI and treatment more than doubled (116%). No significant differences in case investigation data quality were found between CD Techs and PHNs. Qualitative interviews by public health staff (n = 24) found CD Techs highly flexible and competent team members who can fill gaps and expand capacity in direct client service, outreach, administration, data entry, or community/partner engagement.

Implications: Mentorship, ongoing supervision, role clarity, training, and clear practice standards are required to optimize the role. There is potential to expand this innovation and build surge capacity in other areas of public health practice, and other public health jurisdictions.