Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries

Abstract

BackgroundTask shifting has become an increasingly popular way to increase access to health services, especially in low-resource settings. Research has demonstrated that task shifting, including the use of community health workers (CHWs) to deliver care, can improve population health. This systematic review investigates whether task shifting in low-income and middle-income countries (LMICs) results in efficiency improvements by achieving cost savings.MethodsUsing the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL, and the Health Economic Evaluation Database on March 22, 2016. We included any original peer-review articles that demonstrated cost impact of a task shifting program in an LMIC.ResultsWe identified 794 articles, of which 34 were included in our study. We found that substantial evidence exists for achieving cost savings and efficiency improvements from task shifting activities related to tuberculosis and HIV/AIDS, and additional evidence exists for the potential to achieve cost savings from activities related to malaria, NCDs, NTDs, childhood illness, and other disease areas, especially at the primary health care and community levels.ConclusionsTask shifting presents a viable option for health system cost savings in LMICs. Going forward, program planners should carefully consider whether task shifting can improve population health and health systems efficiency in their countries, and researchers should investigate whether task shifting can also achieve cost savings for activities related to emerging global health priorities and health systems strengthening activities such as supply chain management or monitoring and evaluation.

Satisfaction of a new telephone consultation service for prenatal and postnatal health care

“…21 The community-based task shifting between obstetricians and nurses has become a popular way to improve heavy workload of obstetricians. 10,22 An alternative to the face-to-face consultation in health care could alleviate physician workload and improve patient access. 23 Thus, the nurse-led telephone consultations may provide a promising alternative and supporting service for face-to-face general practice visits.…”

Strengthening the Health Care Workforce in Fragile States: Considerations in the Health Care Sector and Beyond

“…). This argument also aligns with task‐shifting efforts that are gaining momentum and demonstrating significant potential to improve population health in the developing world, while achieving cost savings (Seidman and Atun ). For instance, the WHO has developed specific recommendations for tasks related to maternal and neonatal health (e.g., neonatal resuscitation, intrauterine device placement, and removal) that can be safely carried out by health care workers who are not physicians (WHO ).…”

Team‐based care for hypertensive patients is essential in low‐ and middle‐income countries

“…In LMICs, task sharing generally between clinicians, nurses, community health workers and lay counselors for communicable disease can generate cost savings and improve efficiency in health services . Furthermore, the findings of Myanganbayar et al, that nurses rated medication affordability and patients' agreement with the treatment plan higher on average than physicians, potentially align with the Cochrane Review findings that NMP is likely to improve patient adherence …”