Abstract
BackgroundDemographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for complex and chronic conditions in the 0–19 years (paediatric) age range. Providing such services will be undermined by general and skilled paediatric workforce shortages especially in low- and middle-income countries (LMICs). In this paper, we aim to understand existing, sanctioned forms of task-sharing to support the delivery of care for more complex and chronic paediatric and child health conditions in LMICs and emerging opportunities for task-sharing. We specifically focus on conditions other than acute infectious diseases and malnutrition that are historically shifted.MethodsWe (1) reviewed the Global Burden of Diseases study to understand which conditions may need to be prioritized; (2) investigated training opportunities and national policies related to task-sharing (current practice) in five purposefully selected African countries (Kenya, Uganda, Tanzania, Malawi and South Africa); and (3) summarized reported experience of task-sharing and paediatric and child health service delivery through a scoping review of research literature in LMICs published between 1990 and 2019 using MEDLINE, Embase, Global Health, PsycINFO, CINAHL and the Cochrane Library.ResultsWe found that while some training opportunities nominally support emerging roles for non-physician clinicians and nurses, formal scopes of practices often remain rather restricted and neither training nor policy seems well aligned with probable needs from high-burden complex and chronic conditions. From 83 studies in 24 LMICs, and aside from the historically shifted conditions, we found some evidence examining task-sharing for a small set of specific conditions (circumcision, some complex surgery, rheumatic heart diseases, epilepsy, mental health).ConclusionAs child health strategies are further redesigned to address the previously unmet needs careful strategic thinking on the development of an appropriate paediatric workforce is needed. To achieve coverage at scale countries may need to transform their paediatric workforce including possible new roles for non-physician cadres to support safe, accessible and high-quality care.
Highlights
Demographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for complex and chronic conditions in the 0–19 years age range
The World Health Organization (WHO) estimates a gap in the supply of 18 million health workers by 2030 mostly in lowand middle-income countries (LMICs) [5] where there is likely to be a specific challenge with the skilled paediatric workforce
We conducted three parallel activities: (1) we explored which conditions have the highest disease burden for those aged 0–19 years using patterns in middle and high-income countries to indicate likely future scenarios in LMICs; (2) we investigated the training opportunities and existing policy related to task-sharing that might support expanded paediatric and child health services in five purposefully selected African countries; and (3) we conducted a scoping review of research examining task-sharing for child and adolescent health in LMICs with a specific focus on conditions other than acute infectious diseases and malnutrition that are historically shifted
Summary
Demographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for complex and chronic conditions in the 0–19 years (paediatric) age range Providing such services will be undermined by general and skilled paediatric workforce shortages especially in lowand middle-income countries (LMICs). The transition to the Sustainable Development Goals (SGDs) prompted the global community to look forwards to broaden the agenda as part of “child health redesign” [3] This includes care for complex and chronic conditions in the 0–19 years age range (referred to in this paper as paediatric and child health care) that were previously neglected and that most health systems in low- and middle-income countries (LMICs) may not be well-designed to address [3, 4]. This leads to either de facto task-shifting or a lack of paediatric and child health care
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