Coronavirus Coronavirus [CoV]

Sharing and Shifting Tasks to Maintain Essential Healthcare During COVID-19 in Low Resource, non-US settings

Purpose The coronavirus disease 2019 (COVID-19) pandemic has placed a substantial burden on many healthcare systems worldwide as they struggle to treat both COVID-19 patients and maintain essential primary care services. The burden may be even greater in low-resource non-US settings, where healthcare systems are often already overtaxed and struggling to provide services to patients…

Purpose

The coronavirus disease 2019 (COVID-19) pandemic has placed a substantial burden on many healthcare systems worldwide as they struggle to treat both COVID-19 patients and maintain essential primary care services. The burden may be even greater in low-resource non-US settings, where healthcare systems are often already overtaxed and struggling to provide services to patients in need due to a shortage in the healthcare workforce.

The World Health Organization (WHO) outlines two approaches to expand and ensure access to essential health services by optimizing the use of the existing healthcare workforce: task shifting and task sharing1 2. Task shifting and task sharing allow for the shifting of tasks from highly qualified healthcare workers (HCWs) to HCWs with less training and less qualifications and the sharing of tasks with an equally qualified cadre of HCWs, respectively. This allows for more efficient use of available human resources working in overburdened health systems during the COVID-19 pandemic.

These two strategies may be one part of a larger strategy to expand and strengthen health system capacity to increase access to COVID-19 care while maintaining essential health services. Additionally, these strategies can help protect and maintain the health and wellbeing of the healthcare workforce by reducing their workload and strategically using staff who are at higher risk of severe illness from COVID-19 in a way that decreases their risk of exposure to the virus that causes COVID-19.

Target Audience

These considerations are intended for countries where access to basic essential health services is constrained due to the COVID-19 pandemic, that have an underlying health workforce shortage, and that are considering implementation of a task shifting or sharing approach to strengthen and expand the health workforce for the delivery of COVID-19 care and other essential health services. Primarily this document is aimed at health care policy makers, program managers and staff in Ministries of Health who manage human resources for health along with local and international organizations providing essential health services that have been affected by the pandemic.

Definitions

Task shifting and task sharing reflect the same intention – to include cadres who do not normally have competencies for specific tasks to deliver them and to thereby increase levels of health care access. Both emphasize the need for training and continued educational support of all cadres of health workers in order for them to undertake the tasks they are to perform. Additionally, routine supportive supervision and a well-functioning referral system are essential preconditions for success.  The suggestions in this document generally apply to task sharing and task shifting approaches.

Task shiftingexternal icon is the process of delegation whereby tasks are moved, where appropriate, to less specialized HCWs1. This reorganization of the workforce, along with expanded training and retention programs, can allow a health system to more efficiently use the existing workforce and ease bottlenecks in service delivery while also expanding workforce capacity1 2.

Task sharing increases the categories of HCWs who can deliver certain health services. With task sharing, tasks are not taken away from one cadre or set of HCWs and given to another, but they are shared across groups2. Task sharing enables low- and mid-level health professionals to perform tasks and procedures that would normally be restricted to higher level health professionals, thereby freeing up time for these higher-level providers within a health system.

Basics of Task Sharing and Task Shifting

HCWs may face poor working conditions, low pay, and a sense of being overburdened due to an increase in demand without a comparable increase in a skilled workforce to share the workload in an equitable manner. In addition, in the face of the COVID-19 pandemic frontline HCWs are challenged with putting themselves and their immediate and extended families at risk for contracting the virus that causes COVID-19.

Ultimately the goal of task shifting and sharing in the era of the COVID-19 pandemic is to standardize, simplify, and decentralize systems to maximize the role of primary health care and community based care as it relates to the provision of COVID-19 clinical care1.  Good management, supportive supervision, and political will are important for ensuring successful outcomes from task shifting and sharing.

Steps to Consider for Implementation of Task Shifting or Sharing

Given the urgent need to keep essential health services functional during the COVID-19 pandemic, the steps below take into consideration the following: the demand placed on health systems by COVID-19, the legal/ regulatory environment, characteristics of the health system involved, possible resource constraints in low income settings, and what to consider when developing an implementation plan. These steps and considerations have been generalized to be applicable to most situations. Given the uniqueness of each environment in which these steps could be implemented, additional considerations specific to that environment may need to be considered.  Additional references and resources can be found in Annex III.

Annex I. Sample Delegation Decision-Making Tree

A Delegation decision-making tree

Annex II

The following table describes examples of tasks under specific health programs that may be shifted or shared. It is assumed that shifting and/or sharing of these tasks comes with adequate training, monitoring, and supervision as described in this document.

Annex III.  Resources and Relevant Sites

Task Shifting and Task Sharing-general:

Surgery and Anesthesia:

Management of Chronic Conditions:

Mental Health:

Maternal, Newborn, and Child Health Care

Economic Impact of Task Shifting:

Considerations in Protecting Healthcare Workers

References

  1. WHO, Treat, Train, Retain. The AIDS and health workforce plan. Report on the consultation on AIDS and human resources for health., Geneva: World Health Organization , 2006.
  2. WHO, Task sharing to improve access to Family Planning/Contraception: Summary brief, Geneva: World Health Organization, 2012, p. 3.
  3. WHO, Task shifting to tackle health worker shortages, 2007.
  4. WHO, Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines, Geneva: World Health Organization, 2008, p. 7.
  5. WHO, “WHO Recommendations on task shifting components of antenatal care deliveryexternal icon,” 28 March 2018. [Online].
  6. WHO, Guideline: Managing possible bacterial infection in young infants when referral is not feasible, Geneva: World Health Organization, 2015.
  7. WHO, Package of essential noncommunicable (PEN) disease interventions for primary health care in low resource settings, Geneva: World Health Organization, 2010.
  8. WHO, mhGAP Humanitarian Intervention Guide (mhGAP-HIG): clinical management of mental, neurological and substance use conditions in humanitarian emergencies, Geneva: World Health Organization, 2015.
  9. Jhpiego, “Resources: Delegation Decision Treepdf iconexternal icon,” [Online]. [Accessed 16 June 2020].
  10. WHO, Guidelines for treatment of drug-susceptible tuberculosis and patient care, 2017 update, Geneva: World Health Organization, 2017.
  11. Ariadne Labs, “News: Tackling the Covid-19 Human Resource Emergencyexternal icon,” Ariadnes Labs, June 2020. [Online]. [Accessed June 2020].
  12. K. Tulenko and N. D’Lima, “MedicineNet: How Surge Staffing Can Fight COVID-19external icon,” MedicineNet, 15 April 2020. [Online]. [Accessed June 2020].
  13. WHO, Maintaining essential health services: operational guidance for the COVID-19 context: Interim guidance, 1 June 2020, Geneva: World Health Organization, 2020.
  14. WHO, Operational considerations for case management of COVID-19 in health facility and community: interim guidance,, Geneva: World Health Organization, 2020.
  15. WHO and UNICEF, Community-based health care, including outreach campaigns, in the context of the COVID-19 pandemic: Interim guidance, May 2020, Geneva: World Health Organization and United Nations Children’s Fund, 2020.

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