Health workforce skill mix and task shifting in low income countries: a review of recent evidence
Brent D. Fulton,Richard M. Scheffler,Susan Sparkes,Erica Yoonkyung Auh,Marko Vujicic,Agnes Soucat +5 more
TLDR
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.Abstract:
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.read more
Citations
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Relationship between retention factors and affective organisational commitment among knowledge workers in Malaysia
TL;DR: In this paper, the issues that influence affective commitment among knowledge workers in Malaysia were explored from the Malaysian knowledge workers' perspective including compensation, career opportunity, training and development, supervisor support, job autonomy, work life policies and skill varieties.
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A situation analysis of psychiatrists in South Africa’s rural primary healthcare settings
TL;DR: Because of a lack of MH nurses and medical officers dedicated to MH in PRPHC facilities, recommendations are made that the current task shifting strategy be revisited to include more cadres of MH professionals with specialised psychopharmacological training, as non-medical prescribers atPRPHC level.
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How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review
Roxanne J. Kovacs,Timothy Powell-Jackson,Søren Rud Kristensen,Neha S. Singh,Josephine Borghi +4 more
TL;DR: There is substantial heterogeneity in the design of P4P schemes in LMICs and the results highlight that incentive design is not adequately being reported on in the literature – with many studies failing to report key design features.
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District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries.
Barclay T. Stewart,Adam Gyedu,Adam Gyedu,Robert Quansah,Robert Quansah,Wilfred Larbi Addo,Akis Afoko,Pius Agbenorku,Pius Agbenorku,Forster Amponsah-Manu,James Ankomah,Ebenezer Appiah-Denkyira,Peter Baffoe,Samuel Debrah,Peter Donkor,Peter Donkor,Theodor Dorvlo,Kennedy B. Japiong,Adam L. Kushner,Adam L. Kushner,Martin Tangnaa Morna,Anthony Ofosu,Victor Oppong-Nketia,Stephen Tabiri,Charles Mock +24 more
TL;DR: Given the successes of similar filters in HICs and obstetric care filters in LMICs, the collection and reporting of prospective trauma care audit filters may be an important step towards improving care for the injured at district-level hospitals in LM ICs.
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Programme level implementation of malaria rapid diagnostic tests (RDTs) use: outcomes and cost of training health workers at lower level health care facilities in Uganda
Daniel J Kyabayinze,Daniel J Kyabayinze,Caroline Asiimwe,Damalie Nakanjako,Jane Nabakooza,Moses Bajabaite,Clare E. Strachan,James K Tibenderana,Jean Pierre Van Geetruyden +8 more
TL;DR: One-day training on the use of RDTs successfully provided adequate skill and competency among health workers to perform R DTs in fever case management at LLHF in a Uganda setting.
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