Perspectives of health workers engaging in task shifting to deliver health care in low-and-middle-income countries: a qualitative evidence synthesis

ABSTRACT

Background

Low- and middle-income countries (LMICs) are experiencing growing demand for healthcare services yet face a persistent shortage in access to specialist health workers (SHWs). Task shifting is an approach used to address this gap in service provision. Specific healthcare tasks are shifted to other, larger cadres of non-specialist health workers (NSHWs), including lay health workers with SHWs potentially taking on supervisory roles. Previous studies demonstrate that task shifting is both clinically and economically effective, however the impact of task shifting on health workers (HWs) is not fully understood.

Objective

The aim of this synthesis is to generate new knowledge about what influences HWs perspectives of benefits and costs of engaging in task shifting.

Methods

A qualitative evidence synthesis (QES) of peer-reviewed literature using databases CINAHL, the Cochrane Database of Systematic Reviews, Psych INFO, MEDLINE, EMBASE, Epistimonikos, Web of Science (science and social science citation index), Scopus LILACS, the African Index Medicus and Google Scholar. Eligible studies were those that included qualitative data about HWs perspectives of task shifting in LMICs. Information from eligible studies was extracted into a Google Sheet, and the data gathered were analysed thematically.

Results

Fifty-four studies were included in the QES. Results were organised under three themes, ‘the cultural environment in which task shifting is employed’, ‘access to resources for task shifting’ and ‘alignment with personal values and beliefs, self-efficacy and personal emotional resilience’.

Conclusion

This is the first review bringing together views about task shifting from the perspective of different cadres of HWs drawn from diverse healthcare, geographical and country settings in LMICs. Task shifting is a complex process which relies upon the active engagement of HWs. Taking into consideration factors that influence HWs perspectives, such as their personal characteristics, preparatory training, and ongoing access to resources, is important for informing how task shifted healthcare initiatives are designed and delivered to successfully widen access to healthcare in LMICs.

KEYWORDS:

• Healthcare
• LMICs
• low-resource settings
• review
• nurse
• maternal, child
• HIV
• mental health
• non-communicable diseases
• communicable diseases

Responsible Editor

Maria Nilsson

Responsible Editor

Maria Nilsson

Acknowledgments

We would like to acknowledge the contributions of Professor David Ekers, Professor Helen Elsey, Professor Richard Holt and Dr Jenny Lewis, for supporting the development and conduct of this review in their role as Karen Coales’ PhD thesis advisory panel. We would like to thank David Brown, Specialist Librarian, University of York and Dr Judy Wright, Specialist Librarian, University of Leeds for their invaluable assistance in developing the search strategy.

Author contribution

KC conceived and designed the QES and extracted the data. KC, AA, MB & FS screened studies for inclusion in the QES. KC, MB & HJ appraised the quality of included studies. KC & HJ analysed and interpreted the data. KC drafted the manuscript. HJ, NS & SA undertook critical review of the manuscript. All authors approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Paper context

Healthcare in LMICs is typically underfunded and under-resourced. Although task shifting has been widely adopted as a method for addressing these challenges, there is limited knowledge from different settings about how task shifting impacts on health workers. Previous studies have found that task shifting poses both occupational opportunities and risks for HWs in LMICs. Bringing together findings from these studies enabled us to identify commonalities in factors across settings that influence HWs perceptions of what the benefits and costs to themselves are when engaging in task shifting. This knowledge is important in helping policy makers to determine how best to engage and support health workers to deliver future task shifted healthcare initiatives to improve access to healthcare in low human resource settings in all LMICs, particularly in settings where currently little knowledge exists.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2023.2228112.

Additional information

Funding

KC is the recipient of a doctoral scholarship under the DiaDeM Global Health Research programme, which is funded by the National Institute of Health Research [grant reference: Research & Innovation for Global Health Transformation (RIGHT) NIHR200806]. The funders had no involvement in study design, data collection and analysis, writing of the manuscript or decision to submit the article for publication.