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.
Highlights
Task shifting has become an increasingly popular way to increase access to health services, especially in low-resource settings
Study selection We reviewed 791 articles and identified 34 references which analyzed the cost implications of task shifting in Low-income and middleincome countries (LMIC)—22 in sub-Saharan Africa, eight in Asia and four in Central or South America
Of the 32 studies included in the review by Vaughan et al, we excluded 17 and included 15, which means that our review included an additional 19 studies not included in Vaughan et al Of the 17 references included by Vaughan et al that we excluded, 12 were excluded because they did not provide comparison of costs between the task shifted model and another model of care [13,14,15,16,17,18,19,20,21,22,23,24], three reported results from modeling of hypothetical programs rather than actual interventions [25,26,27], one reference did not have a full article available [28], and one reference reported the same data from the same program as another reference already included in our review [29]
Summary
Task shifting has become an increasingly popular way to increase access to health services, especially in low-resource settings. In low-income and middleincome countries (LMICs) of Africa, Asia, and the Middle East, increasing the efficiency of health spending could increase health-adjusted life expectancy by 1–2 years [1]. Human resources for health (HRH) make up a significant portion of health expenditures; in LMICs, spending on salaried health workers makes up 28.7–33.2% of total health expenditure [2]. Improving the efficiency of spending on HRH can improve the efficiency of health systems, which can free up financial and other resources and improve health coverage [3]. According to the World Health Organization (WHO), task shifting “presents a viable solution for improving health care coverage by making more efficient use of the human resources already available and by quickly increasing capacity while training and retention programs are expanded” [4].
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