title: Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence.
abstract: Reducing maternal mortality and providing universal access to reproductive health in resource poor settings has been severely constrained by a shortage of health workers required to deliver interventions. The aim of this article is to determine evidence to optimize health worker roles through task shifting/sharing to address Millennium Development Goal 5 and reduce maternal mortality and provide universal access to reproductive health. A narrative synthesis of peer-reviewed literature from 2000 to 2011 was undertaken with retrieved documents assessed using an inclusion/exclusion criterion and quality appraisal guided by critical assessment tools. Concepts were analysed thematically. The analysis identified a focus on clinical tasks (the delivery of obstetric surgery, anaesthesia and abortion) that were shifted to and/or shared with doctors, non-physician clinicians, nurses and midwives. Findings indicate that shifting and sharing these tasks may increase access to and availability of maternal and reproductive health (MRH) services without compromising performance or patient outcomes and may be cost effective. However, a number of issues and barriers were identified with health workers calling for improved in-service training, supervision, career progression and incentive packages to better support their practice. Collaborative approaches involving community members and health workers at all levels have the potential to deliver MRH interventions effectively if accompanied by ongoing investment in the health care system.
authors: World Health Organization Collaborating Centre in Nursing, Midwifery and Health Development, Faculty of Health, University of Technology, 235-253 Jones Street Broadway, Sydney, NSW 2007, Australia. E-mail: angela.dawson@uts.edu.au.
authors: Angela J
authors: AJ
authors: Dawson
authors: James
authors: J
authors: Buchan
authors: Christine
authors: C
authors: Duffield
authors: Caroline S E
authors: CS
authors: Homer
authors: Kumudu
authors: K
authors: Wijewardena
mesh_terms: D000028:Abortion, Induced; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000706:statistics & numerical data*; D005193:Family Planning Services / Q000458:organization & administration; D005260:Female; D006282:Health Personnel / Q000458:organization & administration; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D011295:Prenatal Care / Q000458:organization & administration; D024382:Professional Role; D034121:Reproductive Health Services / Q000458:organization & administration*; D000078329:Workforce
keywords: Maternal health; health care delivery; human resources for health; reproductive health; skill-mix; task shifting