Task Shifting

This toolkit is simple model that allows patient groups to collect pre-packed, two-month supplies of treatment from lay health workers either at the clinic or outside of the clinic - whether at a local library or at a fellow patients home. Antiretroviral treatment (ART) adherence clubs give stable adherent HIV patients easier access to their treatment, while unclogging clinics and freeing up scarce nurses and doctors to manage new or at-risk HIV patients. [from publisher]

This study attempted to determine the best way to implement new strategies of medical abortion and increase safety and access using auxiliary nurse midwives trained as skilled birth attendants [adapted from author].

This study aimed to contribute an understanding of medicine sellers’ motivations and perceptions of roles in rural and urban North-West Cameroon as providers of first aid care, which is complementary rather than competitive to formal providers. [adapted from author]

This study reviewed Cameroon’s experience with deploying a mid-level cadre of oral health professionals and the feasibility of establishing a more formal and predictable role for these health workers. The authors anticipate that a task-shifting approach in the provision of dental care will significantly improve the uneven distribution of oral health services particularly in the rural areas of Cameroon. [adapted from abstract]

The present study evaluates the cost–effectiveness and cost–utility of a trial task shifting approach to mental health services with the hope that the additional resources needed to train, pay and supervise the lay health workers used in the task-shifting approach to the primary care of common mental disorders would promote recovery and reduced disability in a more cost–effective manner than more conventional care. [adapted from author]

This article outlines a program in South Africa that has developed an innovative mid-level medical worker model that can contribute substantively to the development of quality district-level health care and examines the priorities for expanding and sustaining the program going forward. [adapted from author]

This study sought to determine appropriateness of treatment of common childhood illnesses at private sector drug shops in two rural districts of Uganda. [adapted from abstract]

The aim of this was to describe the current situation of implementing task shifting in the context of acute shortages of health workers and, secondly, and to provide a descriptive account of the potential opportunities or benefits and the likely challenges which might ensue as a result of implementing task shifting. [adapted from abstract]

This study aimed to ascertain the views of key stakeholders on the introduction of a nurse led primary care walk-in center in a rural region of Australia that aimed to fulfill an unmet health care need in the community due to the shortage of general practitioners, meet projected demand for health care services and relieve pressure on the hospital system. [adapted from abstract[

Qualified health workers are expensive and often unavailable for blood pressure screening. In a poor, urban community the authors compared blood pressure measurements taken by non-health workers using electronic devices against qualified health workers. [from abstract]

This book outlines the impact of a package of public health interventions aimed at improving the quality of care of informal village doctors in a rural area of Bangladesh, where village doctors are the primary group of informal healthcare providers practising and dispensing modern medicines. [adapted from publisher]

The objective of this article was to study the role of informal health practitioners in delays in initiating tuberculosis (TB) treatment in new smear-positive TB patients. [from author]

This paper explores gaps and limitations in the conceptualisation, methodology and policy implications of debates about informal health care providers by examining a cross section of empirical studies. [from summary]

Uganda has a severe health worker shortage and a high demand for health care services. This study aimed to assess the policy and programmatic implications of task shifting in Uganda. [from abstract]

The current study compared the effectiveness of trained health surveillance assistants versus trained volunteer key informants in identifying blind children in southern Malawi. [from abstract]

The objective of this study was to assess the willingness of Dutch patients to be treated by a physician assistant or a medical doctor under various time constraints and semi-urgent medical scenarios to determine the patients’ perspectives on using physician assistants as a means to bridge the growing gap between the supply and demand of medical services. [adapted from abstract]

Shifting the role of counseling to less skilled workers may improve efficiency and coverage of health services, but evidence is needed on the impact of substitution on quality of care. This research explored the influence of delegating maternal and newborn counseling responsibilities to clinic-based lay nurse aides on the quality of counseling provided as part of a task shifting initiative to expand their role. [from abstract]

This study evaluated the cost-effectiveness of down-referring stable antiretroviral therapy (ART) patients from a doctor-managed, hospital-based ART clinic to a nurse-managed primary health care facility in Johannesburg, South Africa. [from abstract]

The study aims to compare two task-shifting approaches to the dispensing of anti-retroviral therapy (ART): indirectly supervised pharmacist’s assistants and nurse-based pharmaceutical care models against the standard of care which involves a pharmacist dispensing ART. [adapted from abstract]

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]