Task shifting healthcare services in the post-COVID world: A scoping review

Abstract

AbstractTask shifting (TS) redistributes services from specialised to less-qualified providers. Need for TS was intensified during COVID-19 pandemic. We locate evidences of TS across all health conditions to answer: (A) What role has TS played in services delivery since the onset of the pandemic? (B) How has the pandemic impacted strategies of TS globally? We searched five databases in October 2022: Medline, CINHAL Plus, Elsevier, Global Health and Google Scholar. 35 citations were selected. Data was analysed thematically and reported as per PRSIMA-ScR. We used WHO health systems framework and emergent themes to discuss findings. TS was observed in countries of all income-levels. 63% (n=22) articles discussed what impact TS had in COVID-19 care, mental healthcare, care for HIV, sexual and reproductive health, nutrition and rheumatoid diseases. Others (n=13) highlight how pandemic altered TS strategies in mental healthcare, HIV services, hypertension and diabetes and emergency services. Studies varied in reporting TS; majority using terms “task shifting”, followed by “task sharing”, “task shifting and sharing” and “task delegation”. TS affected every block of health system. TS to non-specialists and non-healthcare staff improved services. Modifying roles through training and collaboration strengthened workforce. TS diagnostics increased access to medicines and technologies. Strategic leadership was key. Research on financing TS during pandemics is required. Stakeholders generally accepted TS. Shifting staff between programs led to unintended service incapacities. Pandemic affected strategies of TS. Training, providing care, follow-ups and consultations went digital. Virtually-delivered interventions improved outcomes. Accessibility to digital technology presented barriers. COVID-19 modified health-seeking behaviour. Patients preferred teleconsultations and online-symptom checkers. Organisations altered operating procedures and patient-flow pathways and added precautions to protect staff. Risks of spreading COVID-19 prompted facilities to reconsider TS. TS improved outcomes by filling workforce gaps and increasing access. We recommend TS to improve services delivery during the pandemic and beyond.