Health workforce skill mix and task shifting in low income countries: a review of recent evidence

Health workforce shortages and skill imbalances are significant challenges, yet task shifting (delegating tasks to new cadres with narrowly tailored training) is a potential strategy to address these challenges. This article reviews take shifting in low-income countries and proposes an agenda for further research.

Findings include:

• by providing health care services at the productively efficient skill mix, more health care services are going to be accessible and affordable to populations seeking care
• the targeted mix which produces the maximum number of health care services at a given quality and cost is to be defined precisely
• a more productively efficient skill mix will partially dampen the effect of health workforce needs-based shortages and better enable countries to meet the health-related United Nations Millennium Development Goals.

Conclusions include:

• task shifting is a policy option that should be considered in developing countries
• future studies should examine the development of new professional cadres that evolve with technology and country-specific labour markets
• skill mix changes need to be evaluated with a rigorous research design to estimate the effect on patient health outcomes, quality of care, and costs
• health care systems should include the necessary incentives for health care administrators to use the most productively efficient skill mix in their local setting.