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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Integrated community case management for childhood illnesses: explaining policy resistance in Kenya
TL;DR: Technical considerations, notably concerns about community health workers dispensing antibiotics, are found to be a key factor slowing iCCM policy development, but this also overlapped with bureaucratic considerations, such as how the development of community health worker cadres may affect clinicians.
Journal ArticleDOI
Task shifting of triage to peer expert informal care providers at a tertiary referral HIV clinic in Malawi: a cross-sectional operational evaluation.
Megan Landes,Megan Landes,Megan Landes,Courtney A. Thompson,Edson Mwinjiwa,Edith Thaulo,Chrissie Gondwe,Harriet Akello,Adrienne K. Chan +8 more
TL;DR: This study provides reassurance that in the context of adequate training and ongoing supervision, task-shifting triage to lay health care workers does not necessarily lead to less accurate triaging.
Journal ArticleDOI
Development, Testing, and Implementation of a Training Curriculum for Nonphysician Health Workers to Reduce Cardiovascular Disease.
Maheer Khan,Pablo Lamelas,Hadi Musa,Jared Paty,Tara McCready,Robby Nieuwlaat,Eleonor Ng,Patricio Lopez-Jaramillo,Jose Lopez-Lopez,Khalid Yusoff,Fadhlina Abd Majid,Kien Keat Ng,Len Garis,Oyere K Onuma,Salim Yusuf,Jon-David Schwalm,Jon-David Schwalm +16 more
TL;DR: The robust curriculum development, testing, and implementation process described affirm that NPHW in diverse settings can be trained in implementing measures for CVD prevention and control.
Journal ArticleDOI
The Vietnam Multicomponent Collaborative Care for Depression Program: Development of Depression Care for Low- and Middle-Income Nations
TL;DR: The Vietnam Multicomponent Collaborative Care for Depression Program was designed to provide evidence-based depression care services in low-resource, non-Western settings such as Vietnam and was found to be acceptable, feasible, and effective in reducing depression outcomes.
Journal ArticleDOI
Student and faculty perceptions on the rapid scale-up of medical students in Ethiopia
Brittney S. Mengistu,Holly Vins,Caitrin M Kelly,Daphne R. McGee,Jennifer O Spicer,Miliard Derbew,Abebe Bekele,Damen Haile Mariam,Carlos del Rio,Henry M. Blumberg,Dawn L. Comeau +10 more
TL;DR: The unprecedented rapid scale-up of medical students has impacted multiple facets of medical education at Addis Ababa University (AAU) and it is important to consider the perspectives of students and faculty in order to focus future medical education policies, MEPI programming and the allocation of resources.
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