Task shifting in health sector

Pakistan faces several workforce challenges with a bearing on the functionality of the One Health systems

Task shifting in health sector


ne Health systems are understood as “the wide range of roles and responsibilities and interactions among diverse actors seen in systems that deal with multi-sectoral challenges”. One Health systems build on the development of processes “that can be used to evaluate existing systems, foster synergies across agencies and improve multi-sectoral preparedness, detection and response to complex One Health challenges.”

The building blocks concept has been adopted by the World Health Organisation for human health systems, conceptualising these based on six building blocks: service delivery; health workforce; health information systems; access to essential medicines; financing; and leadership/governance.

Since its launch in 2007, this framework has been widely considered instrumental in strengthening human health systems, and as a catalyst for achieving global health targets, such as the Sustainable Development Goals.

Attaining health goals depends largely on the knowledge, skills, motivation and deployment of the people responsible for organising and delivering services. Many countries, however, lack the human resources needed to deliver integrated health interventions for a number of reasons, including inadequate planning, limited relevant production capacity, poor mix of skills and demographic imbalances.

In order to achieve a paradigm shift towards a One Health approach, Pakistan faces several workforce challenges with a bearing on the functionality of the One Health systems, including the trends of the burden of disease.

These challenges arise from a host of factors, including low capacity for human resources planning; a poor assembly line of health workers; and a high attrition rate of existing health workers. Other challenges include inequitable distribution of the health workforce; retention of health workers; and high workloads.

Strengthened One Health systems include enhanced One Health workforce capacities, investment and infrastructure at all levels. These challenges can be addressed through task shifting and sharing, which involves redistribution of health tasks within workforces and communities. Specific tasks are moved, shared or delegated, usually from highly trained health workers to those with shorter training or fewer qualifications, including lay people.

The generalised purpose statement indicates that task shifting and sharing is intended to reduce morbidity, mortality and the burden of disease among populations where the inaccessibility of professionalised cadres limits access to effective care.

A conceptual framework for this approach is the COATS (Concepts and Opportunities to Advance Task Shifting and Task Sharing) framework. It spotlights opportunities for One Health system improvement arising from task shifting and sharing programmes.

Shortages of trained health professionals are a key threat to health and health equity worldwide. Health systems and professionals face extra burden to respond to new pressures, such as the Covid-19 pandemic, while maintaining the operation of routine services and care.

Due to the protracted inequitable distribution of health workers, especially at the primary level of care, and the low production rate of the skilled health workforce, there is a dire need to develop a National Task Shifting and Sharing Policy. 

Task shifting and task-sharing strategies allow for more efficient use of health human resources, especially as health systems worldwide struggle to maintain essential services while responding to pandemics. The COATS framework defines the purpose and opportunities arising from such programmes as well as laying down criteria for the implementation of these programmes.

Throughout the COATS framework, the term “intervention” is used to refer to the task that is shifted or shared. Interventions in this context may be preventive, curative, therapeutic, diagnostic or another health action. While the WHO defines task shifting as the “rational redistribution of tasks among health workforce teams,” the COATS definition offers a broader concept involving the redistribution or delegation of health care tasks within workforces or communities. This reference to communities underscores the role of lay and informal service providers in such initiatives.

The final section provides criteria for programme developers, policymakers, researchers and other stakeholders to assess if a given condition and context is suited to task shifting/ task sharing. Conditions critical to the success of such a programme in one setting may be less relevant or absent in others.

The criteria for the implementation of a task shifting/ sharing programme are divided into “necessary conditions” and “important considerations.” Necessary conditions refer to features of the available workers, the health problem and the intervention that will generally need to be in place to make a task shifting/ sharing successful. For example, workers willing to be trained to deliver the intervention and workers willing to provide that training will both be prerequisites for any successful programme so that programme developers should consider these needs as they conceive of a new initiative.

Important considerations refer to concepts that will enable success in some settings but may be less relevant in others.

The framework does not prescribe a measure or threshold to establish that the criteria have been met. These criteria are intended for interpretation and adaptation to specific context so that practitioners and programme developers can appraise whether and how the criteria have been addressed in their particular circumstances.

Task shifting and task sharing is a promising health systems strategy to address health workforce shortages, transform health care delivery and improve health outcomes and inequities. However, it is not a universal solution to insufficient or inequitable access to care.

Due to the protracted inequitable distribution of health workers, especially at the primary level of care, and the low production rate of the skilled health workforce, there is a dire need to develop a National Task Shifting and Sharing Policy in Pakistan. COATS is a good start towards developing such a policy. The policy should aim to achieve universal health coverage by optimising the use of the existing health workforce to deliver essential health services. It should endorse the rational distribution of tasks from service providerworkers with a longer duration of training to those with a shorter duration towards ensuring improved access to essential health services at primary healthcare centres.

The COATS framework is both comprehensive, adaptable and suited to support refinements across a range of task shifting/ sharing policy and programmes, including planning, decision-making, implementation, evaluation and research worldwide.

The writer is a senior public health leader from Pakistan with international experience of design and management of health systems strengthening initiatives

Task shifting in health sector