Development of an implementation framework for task shifting and task sharing in Africa

Abstract

Achieving universal health coverage (UHC) by 2030 is one of the targets (Target 3.8) of the United Nations Sustainable Development Goals. UHC emphasizes improving access to health services that are people-centred and integrated, and delivered along the life course. Attaining this requires a well-trained, skilled, and motivated health workforce at all levels of the health system. However, this is hampered by a widespread shortage of health workers due to increasing population, and outbreaks of diseases. This necessitates strategies for optimally utilizing existing health workers to improve access to health services. Task shifting and task sharing have been proposed as an approach to efficiently utilize existing health workers to ensure improved access to health services. The shortage of some essential cadres of the health workforce is very acute and systemic that if the services they provide are not transferred or shared with other health workers, the life of the population will be at risk. Transferring or sharing the tasks of a cadre of the health workforce to or with another cadre is termed task shifting and sharing respectively. Currently, there are ongoing deliberations in Africa on the need for an implementation framework to guide the adoption and operationalization of task shifting and task sharing as a key strategy for optimally utilizing the existing health workforce towards the achievement of UHC. Yet, there remains a lack of information on context-specific evidence to support the development of the framework, hence the need to generate evidence on task shifting and task sharing in Africa. To address this gap and to contribute to the body knowledge, an implementation framework for task shifting and task sharing for policy and practice in Africa was developed. To achieve this, a sequential multimethod research design, supported by a scoping review, and qualitative explorative descriptive study was employed in this study. There were four key phases before the dissemination of the study findings. In phase 1, two scoping reviews were conducted to generate needed evidence. The reviews synthesized evidence on the rationale and scope of task shifting and task sharing in Africa, and the health professions’ educations strategies applied to enhance capacities for task shifting and task sharing implementation in Africa. In phase 2, a qualitative study exploring the perceptions of policymakers on the barriers, promoters, and strategies for improving task shifting and task sharing implementation in Nigeria was conducted. Subsequently, evidence generated from the scoping review, and the qualitative explorative-descriptive study were used to develop an implementation framework (phase 3). In phase 4, 36 subject matter experts reviewed the applicability of