https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)61809-7.pdf

The end of AIDS: HIV infection as a chronic disease

Climate change and extreme heat events.

Health workforce needs-based shortages and skill mix imbalances are significant health workforce challenges. Task shifting, defined as delegating tasks to existing or new cadres with either less training or narrowly tailored training, is a potential strategy to address these challenges. 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. Studies primarily from low-income countries published between 2006 and September 2010 were found using Google Scholar and PubMed. Keywords included terms such as skill mix, task shifting, assistant medical officer, assistant clinical officer, assistant nurse, assistant pharmacist, and community health worker. Thirty-one studies were selected to analyze, based on the strength of evidence. First, the studies provide substantial evidence that task shifting is an important policy option to help alleviate workforce shortages and skill mix imbalances. For example, in Mozambique, surgically trained assistant medical officers, who were the key providers in district hospitals, produced similar patient outcomes at a significantly lower cost as compared to physician obstetricians and gynaecologists. Second, although task shifting is promising, it can present its own challenges. For example, a study analyzing task shifting in HIV/AIDS in sub-Saharan Africa noted quality and safety concerns, professional and institutional resistance, and the need to sustain motivation and performance. Third, most task shifting studies compare the results of the new cadre with the traditional cadre. Studies also need to compare the new cadre's results to the results from the care that would have been provided--if any care at all--had task shifting not occurred. Task shifting is a promising policy option to increase the productive efficiency of the delivery of health care services, increasing the number of services provided at a given quality and cost. Future studies should examine the development of new professional cadres that evolve with technology and country-specific labour markets. To strengthen the evidence, skill mix changes need to be evaluated with a rigorous research design to estimate the effect on patient health outcomes, quality of care, and costs.

/pdf/health-workforce-skill-mix-and-task-shifting-in-low-income-45abxfnq84.pdf

Health workforce skill mix and task shifting in low income countries: a review of recent evidence

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)60702-2.pdf

Towards an improved investment approach for an effective response to HIV/AIDS

Background: One potential solution to limited healthcare access in low and middle income countries (LMIC) is task-shiftingthe training of non-physician healthcare workers (NPHWs) to perform tasks traditionally undertaken by physicians. The aim of this paper is to conduct a systematic review of studies involving task-shifting for the management of non-communicable disease (NCD) in LMIC. Methods: A search strategy with the following terms ‘‘task-shifting’’, ‘‘non-physician healthcare workers’’, ‘‘community healthcare worker’’, ‘‘hypertension’’, ‘‘diabetes’’, ‘‘cardiovascular disease’’, ‘‘mental health’’, ‘‘depression’’, ‘‘chronic obstructive pulmonary disease’’, ‘‘respiratory disease’’, ‘‘cancer’’ was conducted using Medline via Pubmed and the Cochrane library. Two reviewers independently reviewed the databases and extracted the data. Findings: Our search generated 7176 articles of which 22 were included in the review. Seven studies were randomised controlled trials and 15 were observational studies. Tasks performed by NPHWs included screening for NCDs and providing primary health care. The majority of studies showed improved health outcomes when compared with usual healthcare, including reductions in blood pressure, increased uptake of medications and lower depression scores. Factors such as training of NPHWs, provision of algorithms and protocols for screening, treatment and drug titration were the main enablers of the task-shifting intervention. The main barriers identified were restrictions on prescribing medications and availability of medicines. Only two studies described cost-effective analyses, both of which demonstrated that task-shifting was costeffective. Conclusions: Task-shifting from physicians to NPHWs, if accompanied by health system re-structuring is a potentially effective and affordable strategy for improving access to healthcare for NCDs. Since the majority of study designs reviewed were of inadequate quality, future research methods should include robust evaluations of such strategies.

/pdf/task-shifting-for-non-communicable-disease-management-in-low-4bauhl23jg.pdf

Task Shifting for Non-Communicable Disease Management in Low and Middle Income Countries – A Systematic Review

Background
Shortages of human resources for health (HRH) have severely hampered the rollout of antiretroviral therapy (ART) in sub-Saharan Africa. Current rollout models are hospital- and physician-intensive. Task shifting, or delegating tasks performed by physicians to staff with lower-level qualifications, is considered a means of expanding rollout in resource-poor or HRH-limited settings.

/pdf/a-systematic-review-of-task-shifting-for-hiv-treatment-and-3xd2y9jfet.pdf

A systematic review of task- shifting for HIV treatment and care in Africa

"We are the heroes because we are ready to die for this country": Participants' decision-making and grounded ethics in an Ebola vaccine clinical trial.

/pdf/what-is-the-evidence-on-applicability-and-effectiveness-of-3j3rj0xx87.pdf

What is the Evidence on Applicability and Effectiveness of Public Health Interventions in Reducing Morbidity and Mortality during Heat Episodes

Globalization and Global Health

Individuals with sickle cell disease (SCD) experience vaso‐occlusive crises (VOC). Historically, VOC episodes have been assessed through medical utilization, thereby excluding events managed at home. In order to validate a daily patient‐reported outcome for patients with SCD to accurately report their VOC status and experience of a pain crisis, a SCD Diary was included in Evaluation of Longitudinal Pain Study in Sickle Cell Disease (ELIPSIS), a longitudinal, six‐month, non‐interventional study. The daily patient‐completed diary included a description of SCD pain crisis, followed by questions on: pain crisis in the past 24 h (VOC Day question; respective response yes or no), worst pain, tiredness, and functioning. Thirty‐five patients with SCD participated in ELIPSIS. Analyses were performed to validate the patient‐reported VOC Day. Mean symptoms and functioning scores on the first or last VOC Day of a VOC Event were compared using t‐tests with the mean of the three non‐VOC Days before and after the event. Mean severity of symptoms and functioning scores on all VOC Days compared to all non‐VOC Days were higher, with statistically significant mean differences between first/last VOC Days and respective three non‐VOC Days (p's < .01). A subset of patients (n = 15) and caregivers (n = 9) were interviewed to evaluate their understanding of the SCD Diary questions. Nearly all confirmed that the pain crisis description accurately described the VOC experience, and participants expressed confidence differentiating SCD crisis pain from everyday pain. These results demonstrate patients can reliably report their experiences with VOC‐related pain crises using the SCD Diary.

M Callaghan

Papers

A systematic review of task- shifting for HIV treatment and care in Africa

"We are the heroes because we are ready to die for this country": Participants' decision-making and grounded ethics in an Ebola vaccine clinical trial.

What is the Evidence on Applicability and Effectiveness of Public Health Interventions in Reducing Morbidity and Mortality during Heat Episodes

Globalization and Global Health

Validation of patient‐reported vaso‐occlusive crisis day as an endpoint in sickle cell disease studies