Task Shifting

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]

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]