Table 6.
Summary of key findings on rationale and scope of task shifting and task sharing in reviewed studies.
| First Author (Year) | Country | Health Services Context | Key Findings |
|---|---|---|---|
| Bemelmans 2010 | Malawi | Access to HIV⁄AIDS care | Rationale: Staff shortages in the levels of care and by location. Scope: HIV testing and counselling from nurses to health surveillance assistant (HSA)/lay counsellor, antiretroviral therapy (ART) initiations from medical doctors to non-physician clinicians—clinical officer, medical assistant, and nurse |
| Kosgei 2010 | Kenya | Access to HIV⁄AIDS care | Rationale: Scarcity of healthcare providers and the need to improve patient outcomes without increasing clinic human resources. Scope: ART care |
| Labhardt 2010 | Cameroon | Access to care for hypertension and type 2 diabetes care | Rationale: Majority of the rural population does not have access to adequate hypertension and diabetes care. Scope: Hypertension and diabetes care |
| Selke 2010 | Kenya | Access to HIV⁄AIDS care | Scope: Delivery of medications and provision of follow-up care to patients on ART in the community with support of an electronic decision tool, and 3 monthly visits to facilities compared to the usual monthly visit. |
| De Wet 2011 | South Africa | Access to HIV⁄AIDS care | Rationale: Shortage of health workers (physicians and nurses). Scope: Task shifting from nurses to community health workers for HIV treatment and care. HIV counselling, drug readiness training, distribution of nutritional supplements, and capturing and updating electronic information. |
| Chibanda 2011 | Zimbabwe | Access to mental health intervention/services | Scope: Depression and other common mental disorders (CMD)—screening and monitoring CMD and in delivering the intervention |
| Gessessew 2011 | Ethiopia | Access to comprehensive obstetric care | Rationale: Shortage of physicians in rural areas. Scope: Comprehensive emergency obstetric care (CEmOC) |
| Jennings 2011 | Benin | Access to maternal and newborn health services | Rationale: Need to expand the role of lay nurse aides. Scope: Counselling in maternal and newborn care. |
| Umar 2011 | Nigeria | Access to HIV⁄AIDS care | Rationale: Long waiting time of HIV/AIDS patients in the clinic due to the high workload of available doctors. Scope: Consultation for HIV patients presenting for routine refill and follow-up visits |
| Tweya 2012 | Malawi | Access to HIV⁄AIDS care | Rationale: Shortage of clinicians and nurses. Scope Provision of antiretroviral therapy (ART) to stable patients. |
| Hoke 2012 | Madagascar | Access to injectable contraceptives | Rationale Lack of access to health facilities. Scope: Injection (re-injection) and counselling of patients. |
| Born 2012 | Zambia | Access to HIV⁄AIDS care | Rationale: Rapid expansion of antiretroviral therapy (ART) using existing health workers. Scope: Provision of counselling, education talks, and adherence support to patients in HIV care. |
| Dambisya 2012 | Uganda | Access to HIV⁄AIDS care, maternal and child health, general healthcare, etc. | Rationale: Severe health worker shortage and a high demand for healthcare services. Scope: Community health workers (CHW) and PLWHA in care and support of AIDS patients, ophthalmic clinical officers conduct cataract surgery, psychiatric clinical officers cover the same scope as the psychiatrists, but are more community-oriented than the psychiatrists, who tend to be mainly hospital-based. Nurses set IV lines in upcountry due to lack of physicians, midwives conduct manual vacuum extraction, manual removal of the placenta, and manual vacuum aspiration due to shortage of doctors. CHWs and community members involved in delivery of expanded program on immunization (EPI) services, etc. |
| Mafigiri 2012 | Uganda | Access to TB care | Rationale: To address barriers to successful DOTS in rural areas. Scope: Directly observed treatment short course (DOTS) |
| Kiweewa 2013 | Uganda | Access to HIV⁄AIDS care | Rationale Shortage of physicians. Scope: ART follow-up care to postpartum women |
| Boullé 2013 | Cameroon | Access to HIV⁄AIDS care | Rationale Shortage of physicians |
| Ledikwe 2013 | Botswana | Access to HIV⁄AIDS care | Rationale: Shortage of health workers. Scope: HIV tests and related counselling at public health facilities |
| Galukande 2013 | Uganda | Access to surgical services | Rationale: Shortage and maldistribution of surgical specialists. Scope: Emergency and essential surgical care |
| Baine 2014 | Uganda | Access to health services | Rationale: Shortage of health workers in Uganda. Scope: Surgical care, sexual and reproductive health, HIV/AIDS, tuberculosis DOTS therapy. |
| Asfaw 2014 | Ethiopia | Access to HIV⁄AIDS care | Scope: Antiretroviral therapy |
| Paul 2014 | Uganda | Access to post-abortion care | Rationale Absence of physicians. Scope: Post-abortion care |
| O’Malley 2014 | Namibia | Access to HIV⁄AIDS care | Rationale: Shortage of physicians. Scope: Antiretroviral treatment services |
| Andriamanjato 2014 | Madagascar, Malawi, and Rwanda | Access to eye care | Rationale: Shortage of health workers trained in eye care. Scope: Primary eye care |
| Eliah 2014 | Kenya, Malawi, and Tanzania | Access to eye care | Rationale: Shortage and maldistribution of ophthalmologists. Scope: Cataract surgery |
| Wiedenmayer 2015 | Tanzania | Access to medicines | Rationale: Severe shortage of pharmaceutical staff. Scope: Pharmaceutical management |
| Mwangala 2015 | Zambia | Access to HIV testing | Rationale: Shortage of human resources. Scope: HIV testing services |
| Suzan-Monti 2015 | Cameroon | Access to HIV⁄AIDS care | Rationale: Shortage of physicians in rural areas. Scope: Initiating antiretroviral therapy (ART) |
| Chamberlain 2015 | Uganda | Access to emergency care services | Rationale: Critical shortages of acute care and healthcare workers in resource-limited settings. Scope: Emergency care services in a rural setting |
| Charyeva 2015 | Nigeria | Access to contraceptive implants | Rationale: Severe shortage of human resources. Scope: Provision of contraceptive implants |
| Agyapon 2015 | Ghana | Access to mental health services | Rationale: Inadequate numbers of psychiatrists. Scope: Mental healthcare |
| Akeju 2016 | Nigeria | Access to maternal health services | Rationale: Non-availability of health personnel at the primary healthcare level. Scope: Detection of early signs of pre-eclampsia |
| Wright 2016 | Malawi | Access to mental health services | Rationale: Improve access to primary mental healthcare. Scope: Primary mental healthcare |
| Gueye 2016 | Senegal | Access to family planning services | Rationale: To improve access to family planning in rural areas and improve contraceptive prevalence. Scope: Provision of family planning services—long-acting reversible contraceptives (LARC), specifically implants and the intrauterine device. |
| Dos Santos 2016 | Mozambique | Access to mental health services | Rationale: To expand access to primary mental healthcare due to low numbers of psychiatrists and psychologists Scope: Delivery of psychiatric care |
| Agyapong 2016a | Ghana | Access to mental health services | Rationale: Expand mental healthcare delivery due to shortage of psychiatrists. Scope: CPNs and CMHOs are primarily responsible for case detection in the community, referral of patients to CPOs and psychiatrists. CPOs are responsible for diagnosing and treating a range of common psychiatric conditions |
| Some 2016 | Kenya | Access to non-communicable diseases (NCDs) care | Rationale: Shortage of health workers at the primary level of care and need to increase access to NCD care in primary healthcare settings. Scope: Management of NCDs (hypertension, diabetes mellitus type 2, epilepsy, asthma, and sickle cell) |
| Agyapong 2016b | Ghana | Access to mental health services | Rationale: Shortage of psychiatrists. Scope: Case detection and referral, and diagnosis and treatment of common psychiatric conditions. |
| Landes 2017 | Malawi | Access to HIV⁄AIDS care | Rationale: Shortage of health workers Scope: Triaging of HIV/AIDS patients |
| Okyere 2017 | Ghana | Rationale: Insufficient health workers. | |
| Tilahun 2017 | Ethiopia | Access to family planning services | Rationale: To improve access to family planning in rural areas and improve contraceptive prevalence. Scope: Provision of long-acting contraceptive (Implanon) family planning services. |
| Bolkan 2017 | Sierra Leone | Access to emergency surgical care | Rationale: Shortage of surgical providers. Scope: Surgical and obstetric emergencies |
| Farley 2017 | South Africa | Access to TB treatment services | Rationale: Shortages of medical officers to implement decentralization of MDR-TB treatment service to outpatient settings/lower-level health facilities. Scope: Multidrug-resistant tuberculosis (MDR-TB) treatment |
| Lulebo 2017 | Democratic Republic of the Congo | Access to hypertension management services | Rationale: Shortage of health workers. Scope: Hypertension management |
| Gyamfi 2017 | Ghana | Access to hypertension management services | Rationale: To expand service delivery to lower levels. Scope: Hypertension management and control |
| Dlamini-Simelane 2017 | Swaziland | Access to HIV⁄AIDS care | Rationale: Decentralized ART provision to improve access. Scope: HIV counselling by lay counsellors (predominantly PLHIV), initiation of patients on ART by nurses |
| Kaindjee-Tjituka 2017 | Namibia | Access to CD4+ testing | Rationale: Roll-out and scale-up of POC CD4+ testing in HCT settings in public health facilities. Scope: Point-of-care (POC) CD4+ testing |
| Naburi 2017 | Tanzania | Access to HIV⁄AIDS care—PMTCT services | Rationale: Reduce nurses’ workload and health system costs. Scope: Prevention of mother-to-child transmission of HIV (PMTCT) service delivery |
| Naikoba 2017 | Uganda | Access to HIV/AIDS and TB services | Rationale: Health worker shortages. Scope: HIV care and treatment |
| Marotta 2018 | Mozambique | Access to HIV/AIDS services for children < 5 years | Rationale: To improve ART initiation and retention of HIV-infected children. Scope: Care for HIV-positive children < 5 years old |
| Davis 2018 | Malawi | Access to contraceptive implants | Rationale: Shortage of nurses/midwives. Scope: Long-acting reversible contraception (LARC) insertion (levonorgestrel (LNG) contraceptive implants) |
| Awolude 2018 | Nigeria | Access to cervical cancer screenings | Rationale: Shortage of doctors and nurses in rural areas. Scope: Screen for cervical cancer using visual inspection with acetic acid |
| Sayed 2018 | Kenya | Access to cancer screenings | Rationale: Scarcity of pathologists in Kenya. Scope: Fine-needle aspiration biopsy cytology and bone marrow aspiration and trephine biopsy |
| Millogo 2019 | Burkina Faso | Access to contraceptives | Rationale Shortage of qualified health staff. Scope: Community health workers (CHWs) to offer oral and injectable contraceptives to new users, and auxiliary nurses and auxiliary midwives to provide implants and intrauterine devices. |
| Tariku 2019 | Ethiopia | Access to contraceptives | Rationale: Shortage of physicians, improve access to surgical services and reduce neonatal mortality. Scope: Caesarean section |
| Wall 2020 | Kenya | Access to mental health services | Rationale: Improve access at the community level. Scope: Community-based family therapy mental health interventions |
| Gbagbo 2020 | Ghana | Access to intrauterine contraceptive device | Rationale: Addressing persistent human resources shortages. Scope: Intrauterine contraceptive device |
| Peresu 2020 | Eswatini | Access to multidrug-resistant tuberculosis (MDR-TB) treatment in rural areas | Rationale: Shortage of human resources for health (HRH) and limited access to multidrug-resistant tuberculosis (MDR-TB) treatment in rural areas. Scope: Directly observed treatment (DOT) supervision and administration of intramuscular MDR-TB injections |
| Lund 2020 | South Africa | Access to mental health services | Rationale: Dearth of mental health professionals. Scope: Psychological treatment for perinatal depression |
| Sevene 2021 | Mozambique | Access to hypertension services | Rationale: Delays in reaching health facilities and insufficient healthcare professionals. Scope: Initial screening and initiation of obstetric emergency care for pre-eclampsia/eclampsia |
| Jacobs 2021 | South Africa | Access to mental health services | Scope: Mental health counselling |
| Yator 2021 | Kenya | Access to HIV/AIDS care | Scope: Interpersonal psychotherapy (IPT-G) for adolescent mothers living with HIV |