The Effect of Mutual Task Sharing on the Number of Needed Health Workers at the Iranian Health Posts; Does Task Sharing Increase Efficiency?

Document Type: Original Article

Authors

1 Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences, Kashan, Iran

2 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran

3 School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background
Nowadays task sharing is a way to optimize utilization of human resources for health. This study was designed to assess the effect of task sharing, mutually between midwives and Family Health Workforces (FHWs), on the number of needed staff across the Iranian Health Posts.
 
Methods
The workload and required number of midwives and FHWs in a Health Post were calculated and compared in two different scenarios of task division using a combined approach for estimating the number of required staff. In the first scenario, the midwives and FHWs provide their specialized services and in the second one, using mutual task sharing, a midwife provides all services traditionally delivered by FHWs and each FHW provides prenatal care in addition to the special tasks. Sensitivity analysis was performed to estimate the effects of different hypotheses.
 
Results
By applying mutual task sharing, the required number of staff for Health Posts was one midwife and two FHWs for a standard population of 12,500; one FHW less than that when no task sharing was applied. Sensitivity analysis illustrated that the number of needed staff is the same in both scenarios when different demographic, epidemiologic, cultural and organizational conditions were applied.
 
Conclusion
Task sharing can reduce the required number of health workers which increases efficiency and productivity at health facilities. However, apart from a need to consider quality, acceptability, and feasibility of care, increasing efficiency must be judged against the contextual circumstances.

Keywords

Main Subjects


  1. World Health Organization (WHO). The World health report 2000: health systems : improving performance. Geneva: WHO; 2000.
  2. World Health Organization (WHO). The World Health Report 2006: Working together for health. Geneva: WHO; 2006.
  3. Daviauda E, Chopra M. How much is not enough? Human resources requirements for primary health care: a case study from South Africa. Bull of the World Health Org 2008; 86: 46-51. doi: 10.2471/BLT.07.042283
  4. Dreesch N, Dolea C, Dal Poz MR, Goubarev A, Adams O, Aregawi M, et al. An approach to estimating human resource requirements to achieve the Millennium Development Goals. Health Policy Plan 2005; 20: 267-76. doi: 10.1093/heapol/czi036
  5. World Health Organization (WHO). WHO recommendations; Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting. Geneva: WHO; 2012.
  6. World Health Organization (WHO). Task shifting to tackle health worker shortages. Geneva: WHO; 2007.
  7. WHO/PEPFAR/UNAIDS. Task shifting : rational redistribution of tasks among health workforce teams : global recommendations and guidelines. Geneva: WHO; 2008.
  8. Hagopian A, Micek MA, Vio F, Gimbel-Sherr K, Montoya P. What if we decided to take care of everyone who needed treatment? Workforce planning in Mozambique using simulation of demand for HIV/AIDS care. Hum Resour Health 2008; 6: 3.
  9. Jerome J, Ivers L. Community health workers in health systems strengthening: a qualitative evaluation from rural haiti. AIDS 2010; 24: S67-72. doi: 10.1097/01.aids.0000366084.75945.c9
  10. The United States Agency for International Development (USAID). Creating an enabling environment for task shifting in HIV and AIDS services: recommendations based on two African country case studies. Washington DC: USAID; 2010.
  11. Padmanathan P, Silva MJ. The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review. Soc Sci Med 2013; 97: 82-6. doi: 10.1016/j.socscimed.2013.08.004
  12. Janowitz B, Stanback J, Boyer B. Task sharing in family planning. Stud Fam Plann 2012; 43: 57-61. doi: 10.1111/j.1728-4465.2012.00302.x
  13. Gessessew A, Barnabas GA, Prata N, Weidert K. Task shifting and sharing in Tigray, Ethiopia, to achieve comprehensive emergency obstetric care. Int J Gynaecol Obstet 2011; 113: 28-31. doi: 10.1016/j.ijgo.2010.10.023
  14. Jennings L, Yebadokpo AS, Affo J, Agbogbe M, Tankoano A. Task shifting in maternal and newborn care: a non-inferiority study examining delegation of antenatal counseling to lay nurse aides supported by job aids in Benin. Implement Sci 2011; 6: 2.
  15. Buttorff C, Hock RS, Weiss HA, Naik S, Araya R, Kirkwood BR, et al. Economic evaluation of a task-shifting intervention for common mental disorders in India. Bull World Health Organ 2012; 90: 813–21. doi: 10.2471/BLT.12.104133
  16. Babigumira JB, Castelnuovo B, Stergachis A, Kiragga A, Shaefer P, Lamorde M, et al. Cost Effectiveness of a Pharmacy-Only Refill Program in a Large Urban HIV/AIDS Clinic in Uganda. PLoS One 2011; 6: e18193. doi: 10.1371/journal.pone.0018193
  17. Sandall J, Homer C, Sadler E, Rudisill C, Bourgeault I, Bewley S, et al. Staffing in Maternity Units: Getting the right people in the right place at the right time. London: The King’s Fund; 2011.
  18. Mavalankar D, Vora KS. The Changing Role of Auxiliary Nurse Midwife (ANM) in India: Implications for Maternal and Child Health (MCH). Ahmedabad: Indian Institute of Management; 2008.
  19. Deputy Ministry for Education, Ministery of Health and Medical Education [homepage on the internet]. [cited 2014 Sep. 29]. Available from: http://mbs.behdasht.gov.ir/uploads/176_315_moshakhasat_KNbehdashtomomi.pdf
  20. Bahadoran P, Alizadeh S, Valiani M. Exploring the Role of Midwives in Health Care System in Iran and the World. Iranian Journal of Nursing and Midwifery Research 2009;14: 117-22.
  21. Fakhri A, Seyedin H, Daviaude E. A combined approach for estimating health staff requirements. Iran J Public Health 2014; 43: 107-15.
  22. World Health Organization (WHO). Workload indicators of staffing need.User’s manual. Geneva: WHO; 2010.
  23. Pileroodi S. District health network. 3rd edition. Tehran: Razavieh publication; 2006. [In persian]
  24. Ministry of Health and Medical Education (MoHME). General Regulations and Principles in the Structure of Development Programs of District Health Networks. Tehran: Network Development and Health Promotion Center of MoHME; 2007. [In persian]
  25. Pileroodi S. Integrated services and a method for assessing human resource. 1st edition. Tehran: Aghigh publication; 1997. [In persian]
  26. Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care 1981; 19: 127-40. doi: 10.1097/00005650-198102000-00001
  27. Shipp PJ. Workload indicators of staffing need (WISN): A manual for implementation. Geneva: WHO; 1998.
  28. Seran SB, Kromoredjo P, Kolehmainen-Aitken RL, Smith J, Darmawan J. Decentralised application of the WISN methodology in the Nusa Tenggara Timur Province. Indonesia: EPOS Health Management; 2009.
  29. Fulton BD, Scheffler RM, Sparkes SP, Auh EY, Vujicic M, Soucat A. Health workforce skill mix and task shifting in low income countries: a review of recent evidence. Hum Resour Health 2011; 9: 1. doi: 10.1186/1478-4491-9-1
  30. Ranson MK, Chopra M, Atkins S, Pozc MRD, Bennetta S. Priorities for research into human resources for health in low- and middle-income countries. Bull World Health Organ 2010; 88: 435-43.doi: 10.2471/BLT.09.066290