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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Journal ArticleDOI
Policy review on the management of pre-eclampsia and eclampsia by community health workers in Mozambique.
Salésio Macuacua,Raquel Catalão,Sumedha Sharma,Anifa Vala,Marianne Vidler,Eusebio Macete,Mohsin Sidat,Khátia Munguambe,Khátia Munguambe,Peter von Dadelszen,Esperança Sevene,Esperança Sevene +11 more
TL;DR: The role of CHWs has evolved over the last 40 years to include care of childhood diseases and basic maternal health counselling and the integration of maternal health in the community health tasks.
Journal ArticleDOI
Capturing complexity in clinician case-mix: classification system development using GP and physician associate data
TL;DR: This CMCS assisted in classifying the differences in case-mix between professions, thereby allowing fairer assessment of the potential for role substitution and task shifting in primary care, but it requires further validation.
Journal ArticleDOI
Benchmarking Global Trauma Care: Defining the Unmet Need for Trauma Surgery in Ghana
TL;DR: Ghana has a large unmet need for operative trauma care and future global surgery benchmarking should consider benchmarks for trauma and other specialties, as well as for different hospital levels.
Journal ArticleDOI
Providing health care in rural and remote areas: lessons from the international space station.
TL;DR: Comparing the international space station’s systems with efforts underway to address the lack of rural and remote health-care services may help clinicians, researchers and policy-makers develop new ideas and improve on existing practices.
Journal ArticleDOI
Informal task-sharing practices in inpatient newborn settings in a low-income setting-A task analysis approach.
Gregory Barnabas Omondi,Georgina A. V. Murphy,Georgina A. V. Murphy,Debra Jackson,Sharon Brownie,Sharon Brownie,Mike English,Mike English,David Gathara,David Gathara +9 more
TL;DR: To describe the complexity and criticality of neonatal nursing tasks and existing task‐sharing practices to identify tasks that might be safely shared in inpatient neonatal settings.
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