Task Shifting

This paper describes task-shifting taking place in health centers and district hospitals in Mozambique and Zambia to identify the perceived causes and factors facilitating or impeding task-shifting, and to determine both the positive and negative consequences of task-shifting for the service users, for the services and for health workers. [adapted from abstract]

This technical brief presents a project in Ethiopia focused on scaling-up efforts in underserved rural communities to enable access to long-acting family planning at the village level through task-shifting to Ethiopia’s health extension worker cadre. [adapted from author]

This article advocates training rural primary health care staff in basic emergency surgery in those areas of South Sudan where there is no access to secondary or tertiary level facilities (i.e. surgical task-shifting). Based on their experience, the authors describe and recommend the type of on-the-job training that they feel is most suitable for this level of staff. [from publisher]

This article aimed to assess the effects on mortality, viral suppression, and other health outcomes and quality indicators of program for task shifting of antiretroviral therapy from doctors to nurses, which provides educational outreach training for nurses to initiate and represcribe. [adapted from summary]

The purpose of this study was to evaluate patient and staff perceptions regarding whether the peer education program as as part of a task-shifting strategy for HIV care relieved the workload on professional health care workers and delivered services of acceptable quality. [adapted from author]

This report looks at how innovations in the skill mix of health workers can improve the quality and availability of health services and reduce costs. It identifies the key success factors and the environment necessary for effective innovation and outlines the main gaps in the evidence base, concluding with recommendations to professionals, governments, development agencies and research bodies. [from publisher]

Internet-based cognitive behavioural therapy for depression has been proven effective when guided by a clinician, less so if unguided. This study sought to determine if guidance from a technician would be as effective as guidance from a clinician to increase the capacity of existing mental health services. [adapted from abstract]

Task-shifting to lay community health providers is increasingly suggested as a potential strategy to overcome the barriers to sustainable antiretroviral treatment scale-up in high-HIV-prevalence, resource-limited settings. This article report on a systematic review of scientific evidence on the contributory role and function of these forms of community mobilisation. [adapted from abstract]

The STRETCH (Streamlining Tasks and Roles to Expand Treatment and Care for HIV) progra was an intervention implemented in South Africa to enable nurses providing primary HIV/AIDS care to expand their roles and include aspects of care and treatment usually provided by physicians. The effects of STRETCH on pre-ART mortality, ART provision, and the quality of HIV/ART care were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of factors affecting the implementation of the program. [adapted from abstract]

This article describes a task shifing intervention in Malawi where a cadre of expert patients was trained to assist with some of the clinical tasks of antiretroviral (ART) services as a way to fill the gap in the availability of health workers. [adapted from author]

This article identifies trends in the evolving practice of rural paramedics and describes key characteristics, roles and expected outcomes for a rural expanded scope of practice model. The study found that paramedics are increasingly becoming first line primary healthcare providers in small rural communities and developing additional professional responsibilities throughout the cycle of care. [from abstract]

This paper presents a case study of a multi-component school health promotion intervention in India that was delivered by lay school health counsellors, who possessed neither formal educational nor health provider qualifications. [from abstract]

This policy brief explores actual performance of emergency obstetric care (EmOC) and other related maternal and newborn health services by Nurses, nurse-midwives, and non-physician clinicians who provided at least one of the EmOC signal functions in the previous three months preceding data collection in hospitals and health centres throughout Malawi, Mozambique, and Tanzania. [adapted from author]

This study describes the process and cost of training to attain competence of lower level health workers to perform malaria RDTs in a public health system setting in eastern Uganda. [from abstract]

This paper draws on experiences scaling-up antiretroviral treatment in three sub-Saharan African countries (Malawi, South Africa and Lesotho) and highlights the main opportunities and challenges posed by task shifting and proposes specific actions to tackle the challenges. [adapted from summary]

This literature review attempted to evaluate the evidence base on the use of task-shifting between community health workers and mid-level providers to increase access to family planning and reproductive health. [adapted from author]

This study examines the issues, in the Ugandan context, with strategies to shift facility and community-based tasks to “expert patients,” clients who are recruited and trained to provide suport services for other clients in facilities and in communities. [adapted from summary]

The objective of this study was to compare compliance with national paediatric HIV treatment guidelines between nurse prescribers and doctors at a paediatric referral centre in Gaborone, Botswana. [from author]

Two studies were conducted to assess modes of male circumcision (MC) service delivery to support the scale-up of MC for HIV prevention in Kenya in the public sector. Both studies examined clinical outcomes of and client satisfaction for MC services provided through task shifting performed by nonphysician clinician and by trained itinerant clinical officers. [adapted from author]

Based on the goals of health care reform, growth in the demand for health care will continue to increase the demand for physicians and, as physician shortages widen, advanced practice nurses and physician assistants will play larger roles. The objective of this study was to assess the capacity of this combined workforce to meet the future demand for clinical services. [from author]

Clinical activities that trainees can be trusted to perform with minimal or no supervision have been labelled as Entrustable Professional Activities. The authors sought to examine what activities could be entrusted to psychiatry trainees in their first year of specialist training. [from abstract]

This review attempts to answer questions that remain on the contribution prescribing by nurses and professionals allied to medicine makes to the care of patients in primary care and define the evidence on which clinicians, commissioners of services and policy makers can consider this innovation. [adapted from abstract]

This article outlines the pilot of a low-cost multi-component intervention for depression and other common mental disorders, locally adapted from problem-solving therapy and delivered by trained and supervised female lay workers, to learn if was feasible and possibly effective and how best to implement it on a larger scale. [adapted from abstract]

The objective of this review was to assess the effects of lay health worker interventions on childhood immunisation uptake. [from summary]

In South Africa, limited human resources are a major constraint to achieving universal antiretroviral therapy (ART) coverage. Decentralization or “down-referral” (wherein ART patients deemed stable on therapy are referred to their closest Primary Health Clinics (PHCs) for treatment follow-up) is being used as a possible alternative of ART delivery care. This cross-sectional qualitative study investigates attitudes towards down-referral of ART delivery care among patients currently receiving care in a centralized tertiary HIV clinic. [from abstract]

Much of current discussion of task shifting focuses on community health workers who are seen as relieving doctors, clinical officers, and especially nurses of some of the health promotion and direct care and support work that professional cadres are frequently unable to deliver because of personnel shortages and distance from communities they service. However, task-shifting cannot work unless close attention is paid both to the systems that support successful implementation and to needed expansion of human resources within overall health care system. [adapted from author]

Task shifting and the integration of HIV care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment. This paper describes the development and content of an intervention involving these two strategies. [from abstract]

The aim of this review was to gain insight into the scientific and professional literature describing the extent to and the ways in which nurse prescribing has been realised or is being introduced in Western European and Anglo-Saxon countries; and to identify possible mechanisms underlying the introduction and organisation of nurse prescribing. [adapted from abstract]

In a Cochrane review on the effects of using lay health workers on maternal and child health and infectious disease control, the authors identified 82 trials that showed promising benefits but whose results were heterogeneous. The objective of this research was to use qualitative studies conducted alongside these trials to explore factors and processes that might have influenced intervention outcomes. [adapted from abstract]

In Malawi, Doctors without Borders is working with the local health system to shift responsibilities from doctors to nurses and lay workers in order to reduce pressure on qualified health staff. This video, part of a 5-clip series, demonstrates tools and models that could help make improved treatment accessible to many more. [from publisher]