Task Shifting

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]

The aim of this study was to explore contemporary lay health worker policy development processes and the extent to which issues of gender are taken up within this process. [from abstract]

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]

This paper describes a systematically developed intervention for a lay health worker delivered, community-based intervention for schizophrenia care in three sites in India. [adapted from abstract]

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]

This call to action advocates for the recognition of the economic and social value of volunteers in public health disaster situations and the development of policies to protect them.

This research aims to answer concerns about the magnitude, determinants and successful ways of reducing lay health worker attrition in health programs. [adapted from abstract]

This brief shows that lay health workers can successfully engage significant numbers of consumers in increasing knowledge and reducing barriers to health care quality. It also discusses the fundamental issues of monitoring performance, obtaining recognition and developing an effective training model. [adapted 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 presentation was part of the University of New South Wales’ short course on managing human resources for health. It outlines an attempt to create a new form of health workforce to not only fill a gap but to deliver services better than traditional health professionals. [adapted from author]

This article evaluates an intensive three-month course developed to train non-physician clinicians for remote health centres to address the unmet need for emergency obstetrical care in rural areas.

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]

A recent online discussion aimed to share evidence and good practice examples of the impact of mid-level providers and offer policy-relevant reflections. This report has been developed based on statements provided by the expert advisers and contributions made by participants as part of the discussion, complemented by a selective literature review. [from foreword]

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]

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]

The objective of this study was to assess the effectiveness of these adherence support workers in adherence counseling, treatment retention for people on antiretroviral therapy and addressing inadequate human resources at health facilities. [from abstract]