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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Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique
Kruk,Pereira,Vaz,Bergström,Galea +4 more
Abstract: Objective To compare the training and deployment costs and surgical productivity of surgically trained assistant medical officers (técnicos de cirurgia) and specialist physicians (surgeons and obstetrician/gynaecologists) in Mozambique in order to inform health human resource planning in a developing country with low availability of obstetric care and severe physician shortages. Técnicos de cirurgia have been previously shown to have quality of care outcomes comparable to physicians.
Journal ArticleDOI
Optimising the benefits of community health workers' unique position between communities and the health sector: A comparative analysis of factors shaping relationships in four countries.
Maryse Kok,Hermen Ormel,Jacqueline E. W. Broerse,Sumit Kane,Ireen Namakhoma,Lilian Otiso,Moshin Sidat,Aschenaki Z. Kea,Miriam Taegtmeyer,Sally Theobald,Marjolein Dieleman +10 more
TL;DR: Policy-makers and programme managers should take into account the broader context and adjust CHW programmes so that they trigger mechanisms that generate trusting relationships between CHWs, communities and other actors in the health system to contribute to enabling CHWs to perform well and responding to the opportunities offered by their unique intermediary position.
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Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions.
Gaurav Sharma,Matthews Mathai,Kim E Dickson,Andrew Weeks,G J Hofmeyr,Tina Lavender,Louise T Day,Jiji Elizabeth Mathews,Sue Fawcus,Aline Simen-Kapeu,Luc de Bernis +10 more
TL;DR: Strengthening national health systems to improve maternal and newborn health will only be possible by addressing specific health system bottlenecks during labour and birth, including those within health workforce, health financing and health service delivery.
Journal ArticleDOI
Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence
TL;DR: Evidence is determined that collaborative approaches involving community members and health workers at all levels have the potential to deliver MRH interventions effectively if accompanied by ongoing investment in the health care system.
Journal ArticleDOI
South Africa's protracted struggle for equal distribution and equitable access - still not there.
TL;DR: The purpose of this contribution is to analyse and explain the South African HRH case, its historical evolution, and post-apartheid reform initiatives aimed at addressing deficiencies and shortfalls.
References
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