TOPICS: Task shifting for health care

Now that all countries are working towards a new goal to achieve the universal health target, one approach that has been used by the health system in the past of Low and Middle Income Countries (LMICs) is task shifting to ensure that even the most vulnerable communities get access to efficient and equitable service delivery.

Task shifting is allocating tasks to health workers by providing customized training, primarily, to provide health care services at minimal cost, without compromising the quality.

Task shifting can be a strong strategy to downsize the issue of inadequate health workforce and studies intimate that almost 25%-70% work of a general physician can be deputed to health workers.

WHO report suggests that 83 countries have less than 22.8 skilled health workers per 10000 population like in Nepal, its 16 (midwives, nurses and doctors)/10,000 population and WHO also recommends skill mix ratio to be 1:3:5 for doctors, nurses and paramedics respectively.

Skill mix is integrating varieties of posts and grades in an organization that can multitask skillfully to deliver services to the population.

These countries are still struggling to achieve adequate skill mix to provide quality health services at low cost; and task shifting can help mitigate the problem of huge human workforce crisis focusing on huge burden of maternal and neonatal health.

In Nepal, in 2005-2009, an intervention was initiated to prevent postpartum hemorrhage, a leading cause of maternal mortality, by giving misoprostol to pregnant mothers, where the task was shifted from skilled birth attendants to female community health volunteers (FCHVs).

This meant reaching pregnant mothers in remote areas at the right time.

The coverage was increased to 72% as compared to 10% initially. In 2010, 2011 and 2014 the government of Nepal scaled up the intervention in four mountain regions, 21 districts and 31 districts, respectively with high involvement of FCHVs.

I assume that task shifting is a better option to bridge the gap where achieving standard skill mix is difficult, this integrated approach, can help achieve universal health coverage.

Better quality services can be given with adequate training and supervision that ultimately covers more population where accessibility is a major issue.

Thus, task shifting addresses the pressing issue of human workforce crises.

Dr. Chhetri is pursuing MPH