Does task shifting among parts of a weak health system help?

Zubia Mumtaz,Patrick Patterson

doi:10.1016/s2214-109x(17)30256-5

Abstract

Does task shifting among parts of a weak health system help?

Highlights

Does task shifting among parts of a weak health system help?. In this issue of The Lancet Global Health, Sajid Soofi and colleagues[1] assessed the effectiveness of adding neonatal bag and mask resuscitation and oral antibiotic therapy for suspected newborn infections to a basic preventive and promotive interventions package delivered by community-based lady health workers (LHWs) in rural Pakistan
Codified in 1978 as a key component of the Alma Ata declaration on primary health care,[4] task shifting has been praised on several fronts for its potential to address health worker shortages, reduce costs for training and remuneration, and shift care to cadres that are more retained in rural areas, which might be considered undesirable postings by highly trained staff.[5,6]
Their findings have, perhaps inadvertently, shed light on a more fundamental question: can task shifting address the structural weaknesses in health systems that are responsible in the first place for failure to provide facility-based newborn care? The taskshifting literature suggests that delegation of tasks from one part of a weak health system to another is no more likely to be successful than the status quo unless more fundamental structural changes to strengthen the health system are brought about.[3,7]

Summary

Introduction

In this issue of The Lancet Global Health, Sajid Soofi and colleagues[1] assessed the effectiveness of adding neonatal bag and mask resuscitation and oral antibiotic therapy for suspected newborn infections to a basic preventive and promotive interventions package delivered by community-based lady health workers (LHWs) in rural Pakistan. —and here is the crux—LHWs attended only 14% of all births and resuscitated just 4% of neonates who were reported to be not breathing after birth.[1] This lack of availability of health-care providers severely restricted the effectiveness of the intervention.

Results

Conclusion