|
Title |
Health workforce skill mix and task shifting in
low income countries: a review of recent
evidence |
Author(s) |
Brent D Fulton, Richard M Scheffler, Susan P Sparkes, et al - Personal Name
|
Subject |
Health Care Management |
Publisher |
Bio Med Central Ltd |
Publishing Year |
2011 |
Specific Detail Info |
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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. |
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