Task Sharing to Support Paediatric Service Delivery in Low- and Middle-income Countries: Current Practice and a Scoping Review of Emerging Opportunities
Zhao Y., Hagel C., Tweheyo R., Sirili N., Gathara D., English M.
Abstract BackgroundDemographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for complex and chronic conditions in the 0-19 years (paediatric) age range. The general and skilled paediatric workforce shortage especially in low- and middle-income countries (LMICs) will impede the provision of additional paediatric services. This paper examines experiences with task sharing as part of the solution to this human resources challenge in LMICs and specifically looks beyond the provision of care for acute infectious diseases and malnutrition that are widely and historically shifted. MethodsWe (1) reviewed the Global Burden of Diseases study to understand which conditions may need to be prioritised; (2) investigated training opportunities and national policies related to task sharing (current practice) in five purposefully selected African countries (Kenya, Uganda, Tanzania, Malawi and South Africa); and (3) summarised reported experience of task sharing and paediatric service delivery through a scoping review of research literature in LMICs published between 1990-2019 using MEDLINE, Embase, Global Health, PsycINFO, CINAHL and the Cochrane Library. ResultsWe found that while some training opportunities nominally support emerging roles for non-physician clinicians and nurses, formal scopes of practices often remain rather restricted and neither training nor policy seems well aligned with probable needs from high-burden complex and chronic conditions. From 83 studies in 24 LMICs, and aside from the historically shifted conditions, we found there is some evidence available for task sharing for a small set of specific conditions (circumcision, some complex surgery, rheumatic heart diseases, epilepsy, mental health). ConclusionAs child health strategies are further redesigned to address the previously unmet needs careful strategic thinking on the development of an appropriate paediatric workforce is needed. To achieve coverage at scale countries may need to transform their paediatric workforce including possible new roles for mid-level cadres to support safe, accessible and high-quality care.