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
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Early appraisal of China's huge and complex health-care reforms
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TL;DR: In this article, the current state of human resources for mental health, needs, and strategies for action are reviewed, and the authors discuss scale-up costs, human resources management, and leadership of mental health in low-income and middle-income countries.
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TL;DR: Evidence concerning CHW program effectiveness can help policymakers identify a range of options to consider, however, this evidence needs to be contextualized and adapted in different contexts to inform policy and practice.
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Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening
Dina Balabanova,Anne Mills,Lesong Conteh,Baktygul Akkazieva,Hailom Banteyerga,Umakant Dash,Lucy Gilson,Lucy Gilson,Andrew Harmer,Ainura Ibraimova,Ziaul Islam,Aklilu Kidanu,Tracey Perez Koehlmoos,Supon Limwattananon,Supon Limwattananon,V. R. Muraleedharan,Gulgun Murzalieva,Benjamin Palafox,Warisa Panichkriangkrai,Walaiporn Patcharanarumol,Loveday Penn-Kekana,Timothy Powell-Jackson,Viroj Tangcharoensathien,Martin McKee +23 more
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References
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Journal ArticleDOI
Hypertension, diabetes mellitus and task shifting in their management in sub-Saharan Africa
TL;DR: The evidences in support of nurse-led strategies for chronic disease management in SSA, with a focus on hypertension and diabetes mellitus are discussed.
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
Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique
TL;DR: To compare the training and deployment costs and surgical productivity of surgically trained assistant medical officers and specialist physicians in Mozambique in order to inform health human resource planning in a developing country with low availability of obstetric care and severe physician shortages.
Report SeriesDOI
Skill-mix and policy change in the health, workforce nurses in advanced roles
James Buchan,Lynn Calman +1 more
TL;DR: An important potential contribution to the efficient use of the health workforce, is the possibility of ‘skill mix’ changes which may involve enhancement of skills among a particular group of staff, substitution between different groups, delegation up and down a unidiscipliniary ladder, and innovation in roles.
Book
Modern labor economics : theory and public policy
TL;DR: In this paper, the authors discuss the labor market and the effects of international trade and production sharing in the US labor market, including gender, race, ethnicity, and race/ethnicity of workers.
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