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 health worker shortages in low-income countries. This study uses an economics perspective to review the skill mix literature to determine the evidence in favour of task shifting, identify gaps in the evidence and propose a research agenda. Thirty-one studies, primarily from low-income countries and published between 2006 and September 2010, were included. First, the studies provide substantial evidence that task shifting is an important policy option to help alleviate workforce shortages and skill mix imbalances. Second, although task shifting is promising, it can present its own challenges, the authors argue, such as 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. The authors conclude that 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.
Human Resources
In response to World Health Assembly resolution WHA57.19, the Director-General has declared the health workforce to be the theme of the World health report 2006. And for the first time, WHO is offering open consultation on the World health report via the World Wide Web and electronic mail. Broad participation is encouraged – from schools for the health professions to national and international financing institutions to the ultimate beneficiaries of health services, the general public. Load https://extranet.who.int/datacol/survey.asp?survey_id=153 and log on using the details Username: whr2006, Password: outline. The page that loads will enable you to make a contribution.
In the absence of benchmarks on the density and distribution of health workers required to achieve universal health coverage (UHC) in developing countries, the authors of this study call for more specific targets that consider country needs and realities, as well as the potential contribution of non-traditional cadres, such as community health workers and mid-level health providers. Multi-pronged approaches for health workforce development, such as task shifting, training and retention efforts, were found to have led to progress in improving coverage for infectious disease control. The authors argue that comprehensive strengthening of the health workforce, and scaling up workforce production for the continuum of maternal, newborn and child health care should be central to the UHC agenda. They recommend that governments and other stakeholders should implement policies and approaches of proven efficacy, such as those enshrined in the Kampala Declaration and Agenda for Global Action, and strengthen the evidence base to better inform policy making. The authors report success stories in the literature review in achieving universal health coverage, but they call for further research into contextual differences enabling these successes before findings may be extrapolated to other contexts.
The World Health Organization (WHO) warns that failure to address problems confronting health workers may push some health systems to the brink of collapse. It describes the grave implications of neglecting health workers' rights in terms of remuneration and working conditions.
In Kenya, more than half of the women deliver without the assistance of a skilled attendant and this has contributed to high maternal mortality rates. The free maternal healthcare services policy in all public facilities was initiated as a strategy to improve access to skilled care and reduce poor maternal health outcomes. This study aimed to explore the perspectives of the service providers and facility administrators of the free maternal health care service policy that was introduced in Kenya in 2013. A qualitative inquiry using semi-structured one-on-one interviews was conducted in Malindi District, Kenya. The participants included maternal health service providers and facility administrators recruited from five different healthcare facilities. Free maternal healthcare service provision was perceived to boost skilled care utilisation during pregnancy and delivery. However, challenges including; delays in the reimbursement of funds by the government to the facilities, stock outs of essential commodities in the facilities to facilitate service provision, increased workload amidst staff shortage and lack of consultation and sensitisation of key stakeholders were perceived as barriers to effective implementation of this policy. The authors note that implementation of the policy would be more effective if; the healthcare facilities were upgraded, equipped with adequate supplies, funds and staff; the community are continually sensitised on the importance of seeking skilled care during pregnancy and delivery; and inclusivity and collaboration with other key stakeholders be fostered in addressing poor maternal health outcomes in the country.
How are hospitals in sub-Saharan Africa (SSA) coping with the large number of children infected with HIV? Can hospital staff deal with the increasing workload? What can hospitals in the developed world do to help?
Cuba recently sent a medical team of 165 internationalist collaborators, consisting of 63 doctors and 102 nurses from across the country, with more than 15 years practical experience and of which 81 % had served on previous international missions. They went to Sierra Leone to support efforts to contain the Ebola outbreak. It is a mission they made clear were happy to undertake that goes to the heart of Cuba’s people-to-people solidarity. The author argues that is affirms that Cuba doesn’t give what it has left over, but its most precious commodity: its sons, its heroes in white coats.
Neil Pakenham-Walsh, Moderator, HIF-net at WHO
Many thanks to all contributors on this subject so far. 22 messages have been posted from 30/1/02 to 15/2/02. Further messages are encouraged through to Friday 8 March, in time for the 'eContent for eDevelopment' workshop in Dar es salaam (11-13 March). After that time, I shall post further summaries and a report of the workshop. Here is a list of contributors and a summary of the discussion so far. All contributors to this discussion (through to Friday 8 March) will be offered a complimentary printed copy of INASP Health Links, a gateway to information for health professionals in developing countries (INASP Health Links will be published in early March 2002).
Dr Tshabala-Msimang said for Africa to scale up health work-force training, there is a need to mobilise adequate resources. She appealed to the developed world which has largely benefited from this exodus of health workers, to consider financially supporting Africa to train more health workers. Additional resources will also be required to rebuild the health infrastructure in some instances as well as training our lecturers, tutors and researchers.
Infant feeding is a subject of worry in prevention of mother to child transmission (PMTCT) programmes in settings where breastfeeding is normative. Nurse-counsellors, expected to counsel HIV-positive women on safer infant feeding methods as defined in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in PMTCT programmes in the Kilimanjaro region, northern Tanzania.