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.