Task Shifting

A postabortion care program was implemented in 11 primary and secondary health facilities in rural Tanzania in order to decentralize comprehensive postabortion care to community level by upgrading midlevel providers to perform manual vacuum aspiration. [from abstract]

This article discusses the issues facing the district training program for emergency obstetric surgery teams in Senegal. [adapted from abstract]

A program to create a cadre of skilled birth attendants for home births was launched by the Government of Bangladesh Bangladesh in 2004. This article suggests that the task-shifting program can only serve as an interim measure rather than a long-term solution as more women decide to seek institutional delivery and professional midwifery care. [adapted from abstract]

This paper provides a literature review and documents existing programmes for task shifting anaesthesia services to mid-level providers in South Asia to increase access to emergency obstetric care and reduce maternal mortality. [adapted from abstract]

To increase access to antiretroviral therapy in resource-limited settings, several experts recommend task shifting from doctors to clinical officers, nurses and midwives. This study sought to identify task shifting that has already occurred and assess the antiretroviral therapy training needs among clinicians to whom tasks have shifted. [from abstract]

In resource-limited settings, serious healthcare worker shortages that contribute to weak health systems exist alongside the drive to scale up ART and other HIV services to reach those in need. The global health community thus needs to reassess current delivery models and pilot new ones that could expand needed healthcare and be more cost effective, while preserving the quality of services. This book provides a roadmap for conceptualizing and initiating the expansion of the nursing scope of practice to include ART prescription and management. [adapted from author]

This article reports on the obstacles to care and the outcome of treatment for patients presenting with tuberculosis to four hospitals in the rural South African region of Sekhukhuneland. [adapted from article]

One of the main barriers to surgical care in resource-limited settings is the shortage of trained health workers. A number of approaches are being employed to overcome this shortage including the mobilization of non-physician clinicians to perform surgical and anesthetic tasks. This paper discusses some of the experiences of surgical task shifting to date, and outlines lessons from task shifting in the delivery of HIV/AIDS care in sub-Saharan Africa. [adapted from abstract]

The delegation of tasks from one cadre to another has been used in many countries for decades. However, rapidly increasing care needs and accelerating human resource crises in Africa have given task shifting new prominence and urgency. This commentary argues that task shifting holds great promise, but that any long-term success of task shifting hinges on serious political and financial commitments. [adapted from abstract]

The Capacity Project partnered with the Ministry of Health and other organizations to perform a pilot study to demonstrate the efficiency and the safety of matrones using active management of the third stage of labor with skilled birth attendants who were authorized to perform the practice and assessed factors that could affect their ability. [from author]

Because of their knowledge of medicines and clinical therapeutics, pharmacists are suitably placed for task shifting in health care and could be further trained to undertake functions such as clinical management and laboratory diagnostics. Indeed, pharmacists have been shown to be willing, competent, and cost-effective providers of what the professional literature calls pharmaceutical care interventions; however, internationally, there is an underuse of pharmacists for patient care and public health efforts. [from abstract]

The Zambia Prevention, Care and Treatment Partnership began training and placing community volunteers as lay counsellors in order to complement the efforts of the health care workers in providing HIV counselling and testing services. These volunteers are trained using the standard national counselling and testing curriculum. This study was conducted to review the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services. [from abstract]

A joint pilot program was launched at the primary health care level in Lesotho through which nurses were trained and empowered to assume high levels of clinical responsibility for HIV care, including ART. This nurse-driven, community-supported model of care has proven to be successful in delivering quality HIV/AIDS and TB services integrated into existing primary health care structures for a population living in remote, rural areas. [from summary]

This report describes field experiences with task shifting in Lusaka, Zambia, where a large public-sector ART program has enrolled over 71,000 HIV-infected adults and children across 19 program sites. It advocates a comprehensive, three-pronged approach to task-shifting that comprises training, on-site clinical mentoring, and continuous quality assurance. A structured approach is important so that clinical care is not compromised when clinical duties are initially shifted to less specialized health professionals. [from introduction]

In the face of medical workforce shortages, governments are looking to displace doctors with alternative health care providers like nurse practitioners, physician assistants, and other health professionals such as psychologists and pharmacists to relieve bottlenecks in health care delivery. Displacing doctors in this way, or role or task substitution as it is also termed, has been actively pursued in the United Kingdom and United States. How should the medical profession react to these developments? [from author]

These reports demonstratre that non-physician clinicians and nurses can take over many of the tasks in providing HIV care and treatment (including ART) in some resource-limited settings. [from author]

This article defines the concept of task shifting, outlines the World Health Organization’s “Treat, Train, Retain’s” recommendations and guidelines on task shifting, gives case study examples of how task shifting can be used, defines the remaining barriers and suggests the conditions necessary for the success of task shifting.

There is good evidence and compelling logic to support the principle of task shifting

The researchers conclude that given the HRH crisis, ART delivery models requiring much less doctor time need to be developed. Overall, there is a need to shift tasks from medical doctors to nurses and from nurses to community health workers. In particular, the patients themselves need to play an important role in the delivery of ART. The outcomes of the various scenarios are predicted. [from author]

There is a gross shortage of nurses, yet there is a need to provide quality care and defend patient care. Widening scope of practice is not new to all categories of nurses and given the Occupational Specific Dispensation for nurses there is a need to critically engage with these issues.

Task shifting should not be viewed as a panacea for the human resources challenges facing sub-Saharan Africa. Rather, it must be part of an overall strategy that includes measures to increase, retain, and sustain health staff. [from author]

The objective of this study was to assess whether traditional birth attendants, drug-shop vendors, community reproductive-health workers, or adolescent peer mobilizers could administer intermittent preventive treatment (IPTp) for malaria with sulfadoxine-pyrimethamine to pregnant women. The study concludes that the use of the guideline with adequate training significantly improved correctness of malaria treatment with chloroquine at home. Adoption of this mode of intervention is recommended to improve compliance with drug use at home. The applicability for deploying artemisinin-based combination therapy at the community level needs to be investigated.

This statement outlines guiding principles to ensure task shifting is effective.

Task shifting, a process whereby medical tasks are delegated to less specialized health-care workers, provides one mechanism to address some of the shortfalls of many health care systems. This article advocates for increased task shifting in health care systems, especially in the developing world. [adapted from author]

Reorganization and decentralization of health services according to a task shifting approach can help to address the current shortages of health workers. This document provides background on task-shifting and twenty-two guidelines for countries that are considering adopting or extending a task-shifting approach to health workforce teams. [from introduction]

The shortage of well-trained health workers is global, but low- and middle-income countries where HIV and AIDS are taking the greatest toll feel the crisis most acutely. This report provides examples and statistics about the potential for task shifting to help with the problem of health worker shortages. [adapted from author]

This study examines the opinions of health professionals about the capacity and performance of the ‘tecnico de cirurgia’, a surgically trained assistant medical officer in the Mozambican health system. Particular attention is paid to the views of medical doctors and maternal and child health nurses. [from abstract]

In both Asia and Latin America, community-based health workers have been trained in safe injection techniques and routinely provide injectable contraception. However, the African continent still resists this service delivery mechanism with the rationale that it is unsafe for clients to receive injections from paramedical personnel. This argument is weakening, however, as non-reusable syringes become the norm and with the recent development of a checklist, based on the latest WHO Medical Eligibility Criteria, for safe provision of DMPA by community-based agents.

Home-based management of malaria (HMM) is promoted as a major strategy to improve prompt delivery of effective malaria treatment in Africa. The published literature was searched for studies that evaluated the health impact of community- and home-based treatment for malaria in Africa. [from abstract]

In parts of rural Africa, where conflict and neglect have destroyed any remnants of a functioning health system, there is one long-running public-health programme that is not only surviving but thriving—by capitalising on communities’ desires to help themselves. [author’s description]