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Improving Maternal and Newborn Care Counselling in Benin: Operations Research on the Use of Job Aids and Task Shifting

This study examined whether a pictorial set of job aids could improve the quality of maternal and newborn care counseling by skilled providers and whether similar performance levels could be achieved by clinic-based lay providers as part of a task shifting initiative to expand their role. [from author]

Reduction of Client Waiting Time Using Task Shifting in an Anti-Retroviral Clinic at Specialist Hospital Bauchi, Nigeria

This study aimed to assess the impact of a task shifting intervention in an ARV clinic in reducing the patients’ waiting time in the clinic. [adapted from author]

Trends and Challenges of Task Shifting to Lay Providers/CHWs

This presentation for the 2008 AIDS Conference outlines the issues in providing HIV treatement with an HRH shortage, task shifiting to lay providers and community health workers (CHWs), trends in lay workers in sub-Saharan Africa, and lessons learned for successful task shifting.

Expanding the Impact: Using Volunteer Healthcare Providers to Expand the Global Health Workforce

This report will address the need to expand the global healthcare workforce and international emergency medical response mechanisms. It will also analyze the current mechanisms and channels that mobilize and coordinate healthcare volunteers in response to international disasters. The report will provide several collaborative pathways through which non-governmental organizations can coordinate their international emergency response efforts with volunteer teams of healthcare providers. [from introduction]

Health Workforce Skill Mix and Task Shifting in Low Income Countries: a Review of Recent Evidence

This study uses an economics perspective to review the skill mix literature to determine its strength of the evidence, identify gaps in the evidence, and to propose a research agenda. [from abstract]

Task Shifting: Maximizing Healthcare in Low-Resource Countries

Low-resource countries often carry the heaviest disease burden and maintain the smallest health workforce. The deadly cholera epidemic in Haiti is only the most recent example of how the time for ‘task shifting’ has arrived. [from author]

Task Shifting in Mozambique: Cross-Sectional Evaluation of Non-Physician Clinicians' Performance in HIV/AIDS Care

This article reports on a nationwide evaluation by the Mozambican Ministry of Health of the quality of care delivered by non-physician clinicians after a two-week in-service training course emphasizing antiretroviral therapy. [adapted from abstract]

Human Resources in Humanitarian Health Working Group Report

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]

Nurse Led, Primary Care Based Antiretroviral Treatment Versus Hospital Care: a Controlled Prospective Study in Swaziland

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]

Nurse Versus Doctor Mangement of HIV-Infected Patients Receiving Antiretroviral Therapy (CUORA-SA): a Randomised Non-Inferiority Trial

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]

Thinking Outside the Box to Meet Health Workforce Needs

The author looks at the implications and the training needs of task shifting. [adapted from author]

Creating an Enabling Environment for Task Shifting in HIV and AIDS Services: Recommendations Based on Two African Case Studies

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]

Task Shifting in Swaziland

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]

Task Shifting in Uganda: Case Study

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]

Delegation of GP-Home Visits to Qualified Practice Assistants: Assessment of Economic Effects in an Ambulatory Healthcare Centre

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]

Expanding Access to ART in South Africa: the Role of Nurse-Initiated Treatment

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 in Expanding the Roles of Family Planning Providers

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]

Systematic Review of Task Shifting for HIV Treatment and Care in Africa

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]

Lay Health Workers in Primary and Community Health Care: a Systematic Review of Trials

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]

Task Shifting Routine Inpatient Pediatric HIV Testing Improves Program Outcomes in Urban Malawi: A Retrospective Observational Study

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]

Malawi: Distribution of DMPA at the Community Level: Lessons Learned

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]

Evaluating Different Dimensions of Programme Effectiveness for Private Medicine Retailer Malaria Control Interventions in Kenya

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]

Antiretroviral Treatment Outcomes from a Nurse-Driven, Community-Supported HIV/AIDS Treatment Programme in Rural Lesotho: Observational Cohort Assessment at Two Years

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]

Task Shifting for Scale-up of HIV Care: Evaluation of Nurse-Centered Antiretroviral Treatment at Rural Health Centers in Rwanda

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]

Role of Nonphysician Clinicians in the Rapid Expansion of HIV Care in Mozambique

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]

Pilot Study of the Use of Community Volunteers to Distribute Azithromycin for Trachoma Control in Ghana

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]

National Trends in the United States of America Physician Assistant Workforce from 1980 to 2007

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]

Community-Based Distribution of Injectable Contraceptives in Malawi

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]

Potential Impact of Task-Shifting on Costs of Antiretroviral Therapy and Physician Supply in Uganda

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]

AIDS Treatment and the Health Workforce Crisis in Africa: Task Shifting and Quality of Care in Mozambique

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.