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Increasing interest has been shown in the use of lay health workers (LHWs) for the delivery of a wide range of maternal and child health (MCH) services in low and middle income countries. However, robust evidence of the effects of LHW interventions in improving MCH delivery is limited. The objective of this document is to review evidence from randomized controlled trials on the effects of LHW interventions in improving MCH and addressing key high burden diseases. [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]

In Mozambique, a country with a high HIV burden and a staggering workforce deficit, the Ministry of Health looked to past experience in workforce expansion to rapidly build ART delivery capacity, including reliance on existing nonphysician clinicians (NPC) to prescribe ART and dramatically increasing the output of NPC training. [from abstract]

The objective of this study was to assess the skills of community health volunteers in diagnosing active trachoma, the world’s leading cause of preventable blindness, and distributing azithromycin treatment in the Northern Region of Ghana. [adapted from author]

The physician assistant (PA) profession is a nationally recognized medical profession in the United States of America. The authors examined the 1980-2007 US census data to determine the demographic distribution of the PA workforce and PA-to-population relationships. Maps were developed to provide graphical display of the data. [adapted from abstract]

This report presents research findings on the potential for making contraceptives, and in particular injectable contraceptives, widely available through using a community-based distribution approach which would expand the cadre of providers authorized to provide contraceptives to include health surveillance assistants and community-based distribution agents. [adapted from summary]

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]

This video highlights task shifting in Tanzania where many areas rely on assistant medical officers to fill the gap caused by the severe doctor shortage. It also touches on the training of these workers to provide medical care in areas without doctors.

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 details the results of a South African study assessing the feasibility of utilizing volunteers in tracing patients who had defaulted from scheduled psychiatric clinic appointments. [adapted from introduction]

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]