ABCD Analysis of Task Shifting – An optimum Alternative Solution to Professional Healthcare Personnel Shortage

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Abstract

Task shifting is an optimum alternate solution in the healthcare system to address the acute shortage of professionally qualified healthcare workers in developing countries. This will temporarily help in solving the big problem of providing quality and timely health services to the needy people. Despite many trained health care professionals, our health care system is struggling to provide optimum services to the patients due to many reasons including the high burden of infectious diseases, emigration of trained professionals, difficult working conditions, and low motivation by country governments. Even though, the permanent solution to this problem is to create more professional doctors by increasing training courses, training facilities through modifying government policies and enhancing resources to do so, such actions and resultant solutions take a long time to realize in practice. Hence a quick optimum solution is needed to address the critical shortage of trained healthcare professionals. It is logically argued and in many places practically proven that out of many alternatives, the best alternative for healthcare executives in any hospital of primary health centres is the strategic decision of thinking and implementing the so called strategy of taskshifting. In this paper, we have analysed the process of task-shifting by considering its advantages, benefits, constraints, and disadvantages using an analysing technique called ABCD analysing framework. As per the ABCD framework, the various determinant issues of related to the task shifting for organizational health service performance are identified using focus group method are : (1) Organizational Issue, (2) Alternative Acceptors Issue, (3) Donor Physicians Issue, (4) Patients and Relatives Issue (5) Societal Issue, and (6) Country Issue. Each determinant issue has sub-issues called key attributes used for analyzing the advantages, benefits, constraints, and disadvantages which are the four major constructs of the framework. The factors affecting the various determinant issues of for task shifting for each key issues under four constructs are derived and 172 critical constituent elements (CCE) of these factors are listed under the ABCD constructs.

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Task shifting: the answer to the human resources crisis in Africa?

Uta Lehmann, Wim Van Damme, Francoise Barten … (2009)

Ever since the 2006 World Health Report advocated increased community participation and the systematic delegation of tasks to less-specialized cadres, there has been a great deal of debate about the expediency, efficacy and modalities of task shifting. The delegation of tasks from one cadre to another, previously often called substitution, is not a new concept. It has been used in many countries and for many decades, either as a response to emergency needs or as a method to provide adequate care at primary and secondary levels, especially in understaffed rural facilities, to enhance quality and reduce costs. However, rapidly increasing care needs generated by the HIV/AIDS epidemic and accelerating human resource crises in many African countries have given the concept and practice of task shifting new prominence and urgency. Furthermore, the question arises as to whether task shifting and increased community participation can be more than a short-term solution to address the HIV/AIDS crisis and can contribute to a revival of the primary health care approach as an answer to health systems crises. In this commentary we argue that, while task shifting holds great promise, any long-term success of task shifting hinges on serious political and financial commitments. We reason that it requires a comprehensive and integrated reconfiguration of health teams, changed scopes of practice and regulatory frameworks and enhanced training infrastructure, as well as availability of reliable medium- to long-term funding, with time frames of 20 to 30 years instead of three to five years. The concept and practice of community participation needs to be revisited. Most importantly, task shifting strategies require leadership from national governments to ensure an enabling regulatory framework; drive the implementation of relevant policies; guide and support training institutions and ensure adequate resources; and harness the support of the multiple stakeholders. With such leadership and a willingness to learn from those with relevant experience (for example, Brazil, Ethiopia, Malawi, Mozambique and Zambia), task shifting can indeed make a vital contribution to building sustainable, cost-effective and equitable health care systems. Without it, task shifting runs the risk of being yet another unsuccessful health sector reform initiative.

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Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review

Delanyo Dovlo (2004)

Background Substitute health workers are cadres who take on some of the functions and roles normally reserved for internationally recognized health professionals such as doctors, pharmacists and nurses but who usually receive shorter pre-service training and possess lower qualifications. Methods A desk review is conducted on the education, regulation, scopes of practice, specialization, nomenclature, retention and cost-effectiveness of substitute health workers in terms of their utilization in countries such as Tanzania, Malawi, Mozambique, Zambia, Ghana etc., using curricula, evaluations and key-informant questionnaires. Results The cost-effectiveness of using substitutes and their relative retention within countries and in rural communities underlies their advantages to African health systems. Some studies comparing clinical officers and doctors show minimal differences in outcomes to patients. Specialized substitutes provide services in disciplines such as surgery, ophthalmology, orthopedics, radiology, dermatology, anesthesiology and dentistry, demonstrating a general bias of use for clinical services. Conclusions The findings raise interest in expanding the use of substitute cadres, as the demands of expanding access to services such as antiretroviral treatment requires substantial human resources capacity. Understanding the roles and conditions under which such cadres best function, and managing the skepticism and professional turf protection that restricts their potential, will assist in effective utilization of substitutes.