Task Shifting

The objectives of this study are to understand the perspectives of physicians, pharmacists, traditional Chinese medicine practitioners, and dispensers on self-management of patients with chronic conditions, in addition to exploring the possibilities of developing pharmacist-led patient self-management in Hong Kong. [from abstract]

This report summarizes the best available evidence regarding the design and implementation of policies for extending the use of non-medically trained primary health care workers (task shifting) to deliver cost-effective maternal and child health interventions. [from preface]

This study examined whether a pictorial set of job aids could improve the quality of maternal and newborn care counseling by skilled providers and whether similar performance levels could be achieved by clinic-based lay providers as part of a task shifting initiative to expand their role. [from author]

This study aimed to assess the impact of a task shifting intervention in an ARV clinic in reducing the patients’ waiting time in the clinic. [adapted from author]

This presentation for the 2008 AIDS Conference outlines the issues in providing HIV treatement with an HRH shortage, task shifiting to lay providers and community health workers (CHWs), trends in lay workers in sub-Saharan Africa, and lessons learned for successful task shifting.

This study uses an economics perspective to review the skill mix literature to determine its strength of the evidence, identify gaps in the evidence, and to propose a research agenda. [from abstract]

Low-resource countries often carry the heaviest disease burden and maintain the smallest health workforce. The deadly cholera epidemic in Haiti is only the most recent example of how the time for ‘task shifting’ has arrived. [from author]

This article reports on a nationwide evaluation by the Mozambican Ministry of Health of the quality of care delivered by non-physician clinicians after a two-week in-service training course emphasizing antiretroviral therapy. [adapted from abstract]

Task shifting is one avenue for delivering needed health care in resource poor settings, and on-the-ground reports indicate that task shifting may be applicable in humanitarian responses to natural disasters and conflicts. This report evaluates the potential strengths and weaknesses of task shifting in humanitarian relief efforts, and proposes a range of strategies to constructively integrate task shifting into humanitarian response. [adapted from abstract]

Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. This article evaluates the effectiveness of nurse-led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. [from abstract]

Expanded access to combination antiretroviral therapy (ART) in resource-poor settings is dependent on task shifting from doctors to other health-care providers. We compared outcomes of nurse versus doctor management of ART care for HIV-infected patients. [from summary]

The author looks at the implications and the training needs of task shifting. [adapted from author]

This document outlines task shifting, its uses, outlines key findings from research case studies in Uganda and Swaziland, and makes recommendations for the way forward. [adapted from author]

This case study aimed to better understand country-specific policies and regulations on task shifting, health worker attitudes, preferences, required skills, what new types of workers can be brought into the workforce to reduce health manpower deficiencies, and budgetary implications. [adapted from introduction]

The objectives of this case study were to understand the policy and programmatic implications of task shifting in relation to the current roles, responsibilities, and workloads of health workers (especially nurses) within the context of providing high-quality HIV services; explore the policy and programmatic implications of task shifting in the utilization of community health workers and/or people living with HIV to provide peer counseling and related services; and assess the attitudes and perceptions of health workers regarding task shifting. [from summary]

This article examines a project to address the decreasing number of general practitioners (GPs) in rural regions in Germany through the delegation of regular GP-home visits to qualified practice assistants. [adapted from abstract]

This article discusses the implications and issues concerning the implementation of nurse-initiated ART treatment - rather than the legal and regulatory frameworks governing nurse prescibing that dominate the current debate on these types of delivery programs. [adapted from author]

Task shifting, allowing lower-level healthcare providers to perform some of the tasks normally reserved for higher—evel providers, has been proposed as one way to overcome the health workforce shortage. Studies consistently show that task shifting in the provision of HIV services (such as distributing antiretroviral therapy) and other areas of healthcare can increase access, improve the coverage and quality of health services, and reduce the costs of providing services. [adapted form author]

This systematic literature review covers the state of the evidence on task shifting, or delegating tasks performed by physicians to staff with lower-level qualifications, which is considered a means of expanding rollout of antiretroviral therapy in resource-poor or HRH-limited settings. [adapted from abstract]

This study evaluated two models of routine HIV testing of hospitalized children in a high HIV-prevalence resource-constrained African setting. Both models incorporated task shifting, or the allocation of tasks to the least-costly, capable health worker. [from abstract]

In 2008, Malawi piloted the distribution of depo-medroxy progesterone acetate (DMPA), an injectable contraceptive, to the community by Health Surveillance Assistants. This report presents lessons learned during the initial implementation, from gaining stakeholder buy-in to curriculum development, and the initial three months after the training and implementation roll-out. [from abstract]

This study presents evaluation findings of two different programs targeting private medicine retailers for malaria control in Kenya. Key components of this evaluation were measurement of program performance, including coverage, knowledge, practices, and utilization based on spatial analysis. [from abstract]

This successful program highlights how improving HIV care strengthened the primary health care system and validates several critical areas for task shifting that are being considered by other countries in the region, including nurse-driven ART for adults and children, and lay counsellor supported testing and counselling, adherence and case management. [from abstract]

In September 2005, a pilot program of nurse-centered antiretroviral treatment (ART) prescription was launched in three rural primary health centers in Rwanda. We retrospectively evaluated the feasibility and effectiveness of this task-shifting model using descriptive data. [from abstract]

Lower-income countries face severe health worker shortages. Recent evidence suggests that this problem can be mitigated by task-shifting or delegation of aspects of health care to less specialized health workers. We estimated the potential impact of task shifting on costs of antiretroviral therapy and physician supply in Uganda. [from abstract]

This presentation dicusses the import of task shifting to providing health care and AIDS treatment programs to low-resource countries in Africa using Mozambique as an example.

Because of increased demand for injectable contraception coupled with an overburdened clinical health system, countries, particularly in sub-Saharan Africa, have recently expanded the use of non-clinic based approaches in providing this method. In this first review of the available evidence of these efforts, this consultation concluded that there is sufficient evidence to support expansion of community-based health workers providing progestin-only injectable contraceptives, especially DMPA. [from author]

Many developing countries face strains in meeting the demands for provision of health services because of limited medical personnel. This has led to renewed interest in task sharing, also known as task shifting. A key feature of task sharing is that those with less medical or paramedical training can provide some of the same services with the same quality as those with more training. [from author]

The aim of this study is to evaluate the effectiveness and cost-effectiveness of a community pharmacist intervention developed to improve adherence and outcomes of primary care patients with depression. [from abstract]

This two-year study to assessed the usefulness and effectiveness of using paraprofessionals in educating and providing emergency contraceptive pill services to potential users. [from summary]