Table 3.
Perspectives on Task Sharing by World Bank Income Classification
| Task sharing | Total | Low- and Middle-Income Country, Mean (SD) | High-Income Country, Mean (SD) | B-Coefficient | Standard Error | 95% Confidence Interval | P Value | |
|---|---|---|---|---|---|---|---|---|
| Is preferred to task shifting, where new groups/cohorts perform procedures with full autonomy | 1.81 (0.78) | 1.76 (0.77) | 1.90 (0.78) | –0.06 | 0.04 | –0.13 | 0.02 | 0.17 |
| Should require maintenance of certification | 1.95 (0.81) | 1.83 (0.78) | 2.10 (0.83) | –0.10 | 0.04 | –0.18 | –0.03 | 0.01 |
| Should require competency-based certification | 1.96 (0.79) | 1.88 (0.73) | 2.07 (0.84) | –0.08 | 0.04 | –0.15 | 0.00 | 0.06 |
| Should require standardized training endorsed by a governing organization | 1.97 (0.81) | 1.91 (0.79) | 2.06 (0.83) | –0.05 | 0.04 | –0.13 | 0.02 | 0.16 |
| Can improve health care coverage by making more efficient use of the human resources already available | 1.99 (0.70) | 1.92 (0.71) | 2.08 (0.67) | –0.08 | 0.04 | –0.17 | 0.00 | 0.06 |
| Is significantly better than the option of no neurosurgical care | 1.99 (0.80) | 1.92 (0.78) | 2.09 (0.83) | –0.06 | 0.04 | –0.14 | 0.02 | 0.12 |
| Can address the global shortage of neurosurgery providers | 2.11 (0.74) | 2.03 (0.73) | 2.22 (0.76) | –0.08 | 0.04 | –0.17 | 0.00 | 0.05 |
| Should be allowed only after the provider consults a formally trained neurosurgeon (in person or via electronic/telemedicine consultation) | 2.12 (0.90) | 2.00 (0.86) | 2.29 (0.94) | –0.09 | 0.03 | –0.15 | –0.02 | 0.01 |
| Should be a priority where human resources are scarce | 2.13 (0.81) | 2.03 (0.79) | 2.27 (0.82) | –0.09 | 0.04 | –0.17 | –0.02 | 0.02 |
| Can quickly increase capacity while training and retention programs are expanded | 2.21 (0.83) | 2.11 (0.82) | 2.34 (0.83) | –0.09 | 0.04 | –0.16 | –0.01 | 0.02 |
| Will reduce the cost of health worker training | 2.55 (0.92) | 2.46 (0.92) | 2.67 (0.92) | –0.06 | 0.03 | –0.13 | 0.01 | 0.07 |
| Has major safety concerns | 2.59 (1.01) | 2.45 (1.03) | 2.78 (0.95) | –0.08 | 0.03 | –0.14 | –0.02 | 0.01 |
| Will reduce the cost of care for patients | 2.62 (0.93) | 2.51 (0.94) | 2.77 (0.91) | –0.07 | 0.03 | –0.14 | –0.01 | 0.03 |
| Is necessary in my country | 2.69 (1.24) | 2.27 (1.05) | 3.26 (1.26) | –0.16 | 0.02 | –0.20 | –0.11 | <0.001 |
| Will result in similar patient outcomes | 2.73 (1.01) | 2.64 (1.08) | 2.88 (0.91) | –0.06 | 0.03 | –0.12 | 0.00 | 0.07 |
| Should be limited to emergency surgical procedures | 2.73 (1.10) | 2.57 (1.18) | 2.95 (0.95) | –0.08 | 0.03 | –0.13 | –0.02 | 0.01 |
| Is significantly worse than specialist neurosurgical care | 2.79 (1.04) | 2.71 (1.08) | 2.89 (0.96) | –0.04 | 0.03 | –0.10 | 0.02 | 0.21 |
| Is professionally disruptive, because these new roles will encroach on specialties where professionals invest great time and resources into their training | 2.79 (1.09) | 2.71 (1.14) | 2.90 (1.00) | –0.04 | 0.03 | –0.10 | 0.02 | 0.15 |
| Should be limited to general practitioners and general surgeons; nonphysician providers should not be allowed | 2.88 (1.09) | 2.74 (1.14) | 3.09 (0.99) | –0.07 | 0.03 | –0.13 | –0.02 | 0.01 |
| Causes a major reduction in quality of care | 2.90 (1.03) | 2.80 (1.08) | 3.02 (0.95) | –0.05 | 0.03 | –0.11 | 0.01 | 0.09 |
| Should be limited to general surgeons | 2.90 (1.10) | 2.65 (1.14) | 3.24 (0.94) | –0.12 | 0.03 | –0.17 | –0.06 | <0.001 |
| Is necessary only in more rural and/or district hospitals in my country | 2.93 (1.11) | 2.74 (1.06) | 3.18 (1.13) | –0.09 | 0.03 | –0.14 | –0.03 | 0.002 |
| Should not be allowed. Resources should focus only on expanding the training programs for formal, certified neurosurgical positions | 2.97 (1.15) | 2.83 (1.21) | 3.16 (1.03) | –0.06 | 0.03 | –0.11 | –0.01 | 0.03 |
SD, standard deviation.