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
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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
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References
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Can the deployment of community health workers for the delivery of HIV services represent an effective and sustainable response to health workforce shortages? Results of a multicountry study
Francesca Celletti,Anna Wright,John Palen,Seble Frehywot,Anne R. Markus,Alan E. Greenberg,Rafael Augusto Teixeira de Aguiar,Francisco Campos,Eric Buch,Badara Samb +9 more
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Google Scholar’s Ranking Algorithm : An Introductory Overview
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James Buchan,Lynn Calman +1 more
The Effects of a Nurse Case Manager and a Community Health Worker Team on Diabetic Control, Emergency Department Visits, and Hospitalizations Among Urban African Americans With Type 2 Diabetes Mellitus
Tiffany L. Gary,Marian Batts-Turner,Hsin Chieh Yeh,Felicia Hill-Briggs,Lee R. Bone,Nae Yuh Wang,David M. Levine,Neil R. Powe,Christopher D. Saudek,Martha N. Hill,Maura McGuire,Frederick L. Brancati +11 more
TL;DR: In this article, a culturally tailored intervention conducted by an NCM/CHW team reduced ER visits in urban African Americans with type 2 DM, and the rate reduction was strongest for patients who received the most NCM and CHW visits (RD, �31.0; adjusted RR, 0.66; 95% confidence interval [CI], 0.59-1.00).
Posted Content
Improving Health Service Delivery in Developing Countries: From Evidence to Action
TL;DR: This book pulls together available evidence concerning strategies to improve health services delivery in low- and middle-income countries (LMICs), using current methods to assemble a knowledge base and analyze the findings.
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