title: A systematic review of qualitative evidence on barriers and facilitators to the implementation of task-shifting in midwifery services.
abstract: OBJECTIVE
  to synthesise qualitative research on task-shifting to and from midwives to identify barriers and facilitators to successful implementation.
  
  
  METHODS
  systematic review of qualitative evidence using a 4-stage narrative synthesis approach. We searched the CINAHL, Medline and the Social Science Citation Index databases. Study quality was assessed and evidence was synthesised using a theory-informed comparative case-study approach.
  
  
  METHODS
  midwifery services in any setting in low-, middle-, and high-income countries.
  
  
  METHODS
  midwives, nurses, doctors, patients, community members, policymakers, programme managers, community health workers, doulas, traditional birth attendants and other stakeholders.
  
  
  METHODS
  task shifting to and from midwives.
  
  
  RESULTS
  thirty-seven studies were included. Findings were organised under three broad themes: (1) challenges in defining and defending the midwifery model of care during task shifting, (2) training, supervision and support challenges in midwifery task shifting, and (3) teamwork and task shifting.
  
  
  CONCLUSIONS
  this is the first review to report implementation factors associated with midwifery task shifting and optimisation. Though task shifting may serve as a powerful means to address the crisis in human resources for maternal and newborn health, it is also a complex intervention that generally requires careful planning, implementation and ongoing supervision and support to ensure optimal and safe impact. The unique character and history of the midwifery model of care often makes these challenges even greater.
  
  
  CONCLUSIONS
  evidence from the review fed into the World Health Organisation's 'Recommendations for Optimizing Health Worker Roles to Improve Access to Key Maternal and Newborn Health Interventions through Task Shifting' guideline. It is appropriate to consider task shifting interventions to ensure wider access to safe midwifery care globally. Legal protections and liabilities and the regulatory framework for task shifting should be designed to accommodate new task shifted practices.
authors.affiliation: University of Cape Town, South Africa. Electronic address: cj.colvin@uct.ac.za.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Colvin
authors.forename: Jodie
authors.initials: J
authors.lastname: de Heer
authors.forename: Laura
authors.initials: L
authors.lastname: Winterton
authors.forename: Milagros
authors.initials: M
authors.lastname: Mellenkamp
authors.forename: Claire
authors.initials: C
authors.lastname: Glenton
authors.forename: Jane
authors.initials: J
authors.lastname: Noyes
authors.forename: Simon
authors.initials: S
authors.lastname: Lewin
authors.forename: Arash
authors.initials: A
authors.lastname: Rashidian
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000379:methods / Q000458:organization & administration; D008880:Midwifery / Q000379:methods / Q000458:organization & administration; D017146:Models, Organizational; D009746:Nursing, Team; D018743:Perinatal Care / Q000379:methods / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D010563:Personnel Turnover; D011247:Pregnancy; D013192:Staff Development
keywords: Organisation of care; Qualitative research; Systematic review; Task shifting