TABLE 1.

Contrasting arguments for and against task shifting.

Pragmatic	Purist
Rational distribution of tasks in care teams. New cadres perform additional tasks (e.g. defaulter tracing), which will improve the quality of patient care.	Delegation of tasks to already overburdened health workers.
Expanded roles lead to empowerment.	Lowering the required level of competence promotes deprofessionalisation.
Job creation and career progression.	No job description, performance framework or increase in remuneration.
Increased community access to basic health care and improved community engagement. Efficiency of services improves patient satisfaction.	A decrease in quality of care; infringement of the rights of the community to receive care from skilled health workers.
Increased cost effectiveness (increasing the number of services provided at a given quality and cost). Alleviate skill-mix imbalances.	Decisions are based on economic and budget constraints rather than on actual health worker shortages; hidden costs associated with training and supervision.
Only a basic level of training, focused on specific skills, is needed. Some tasks require only focused training.	Comprehensive care requires advanced education, professionalism and ethics. Roles and tasks are continually evolving, requiring ongoing training.
A task-oriented approach improves efficiency of care.	A task-oriented approach causes fragmentation in care.
Ethical responsibility to adapt to the needs of the community and provide equitable access to healthcare.	Ethical responsibility to protect the community and healthcare workers from harm.