Task shifting in health care: the risks of integrated medicine in India

Balsari, Satchit; Simon, G. B.; Nair, Rajalakshmi; Saunik, Sujata; Phadke, M. A.

doi:10.1016/s2214-109x(17)30322-4

Cited by 9 publications

(7 citation statements)

References 4 publications

(2 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Redistribution of medical tasks can be complex, and needs surveillance and monitoring. A programme from India where non‐specialist doctors were trained in emergency obstetrics was discontinued because of a lack of comprehensive monitoring, poor supervision and limited incentives and career prospects.…”

Section: Discussionmentioning

confidence: 99%

Caesarean section performed by medical doctors and associate clinicians in Sierra Leone

Duinen

Kamara

Hagander

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

Background Many countries lack sufficient medical doctors to provide safe and affordable surgical and emergency obstetric care. Task‐sharing with associate clinicians (ACs) has been suggested to fill this gap. The aim of this study was to assess maternal and neonatal outcomes of caesarean sections performed by ACs and doctors. Methods All nine hospitals in Sierra Leone where both ACs and doctors performed caesarean sections were included in this prospective observational multicentre non‐inferiority study. Patients undergoing caesarean section were followed for 30 days. The primary outcome was maternal mortality, and secondary outcomes were perinatal events and maternal morbidity. Results Between October 2016 and May 2017, 1282 patients were enrolled in the study. In total, 1161 patients (90·6 per cent) were followed up with a home visit at 30 days. Data for 1274 caesarean sections were analysed, 443 performed by ACs and 831 by doctors. Twin pregnancies were more frequently treated by ACs, whereas doctors performed a higher proportion of operations outside office hours. There was one maternal death in the AC group and 15 in the doctor group (crude odds ratio (OR) 0·12, 90 per cent confidence interval 0·01 to 0·67). There were fewer stillbirths in the AC group (OR 0·74, 0·56 to 0·98), but patients were readmitted twice as often (OR 2·17, 1·08 to 4·42). Conclusion Caesarean sections performed by ACs are not inferior to those undertaken by doctors. Task‐sharing can be a safe strategy to improve access to emergency surgical care in areas where there is a shortage of doctors.

show abstract

Section: Discussionmentioning

confidence: 99%

Caesarean section performed by medical doctors and associate clinicians in Sierra Leone

Duinen

Kamara

Hagander

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…In the face of impossible workloads, and the toll this takes on staff, the rational and economic case for task-sharing to lower skilled (and lower paid) workers such as HCAs seems clear, suggesting the process could be straightforward. Literature suggests the reality can be rather different 21 35–37. Any new cadre in the public sector would be introduced into settings beset by multiple challenges and with deeply embedded working practices, professional norms and jurisdictions.…”

Section: The Potential Space For Task Sharingmentioning

confidence: 99%

Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

et al. 2020

View full text Add to dashboard Cite

There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses’ well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.

show abstract

“…The public health system is robust in population health interventions like vaccine delivery but struggles to provide quality primary care or specialized services at scale [ 29 ]. There are also stark differences in health care services in rural and urban India, with the majority of the medical workforce, and tertiary services gravitating to urban India [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Reimagining Health Data Exchange: An Application Programming Interface–Enabled Roadmap for India

Balsari¹,

Fortenko²,

Blaya³

et al. 2018

J Med Internet Res

Self Cite

View full text Add to dashboard Cite

In February 2018, the Government of India announced a massive public health insurance scheme extending coverage to 500 million citizens, in effect making it the world’s largest insurance program. To meet this target, the government will rely on technology to effectively scale services, monitor quality, and ensure accountability. While India has seen great strides in informational technology development and outsourcing, cellular phone penetration, cloud computing, and financial technology, the digital health ecosystem is in its nascent stages and has been waiting for a catalyst to seed the system. This National Health Protection Scheme is expected to provide just this impetus for widespread adoption. However, health data in India are mostly not digitized. In the few instances that they are, the data are not standardized, not interoperable, and not readily accessible to clinicians, researchers, or policymakers. While such barriers to easy health information exchange are hardly unique to India, the greenfield nature of India’s digital health infrastructure presents an excellent opportunity to avoid the pitfalls of complex, restrictive, digital health systems that have evolved elsewhere. We propose here a federated, patient-centric, application programming interface (API)–enabled health information ecosystem that leverages India’s near-universal mobile phone penetration, universal availability of unique ID systems, and evolving privacy and data protection laws. It builds on global best practices and promotes the adoption of human-centered design principles, data minimization, and open standard APIs. The recommendations are the result of 18 months of deliberations with multiple stakeholders in India and the United States, including from academia, industry, and government.

show abstract

Task shifting in health care: the risks of integrated medicine in India

Cited by 9 publications

References 4 publications

Caesarean section performed by medical doctors and associate clinicians in Sierra Leone

Caesarean section performed by medical doctors and associate clinicians in Sierra Leone

Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

Reimagining Health Data Exchange: An Application Programming Interface–Enabled Roadmap for India

Contact Info

Product

Resources

About