Elsevier

Social Science & Medicine

Volume 97, November 2013, Pages 82-86
Social Science & Medicine

Short report
The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: A systematic review

https://doi.org/10.1016/j.socscimed.2013.08.004Get rights and content

Highlights

  • This review focuses on acceptability and feasibility.

  • All study designs were included and twenty-one studies were reviewed.

  • Results show task-sharing is not an outright solution for human resource shortages.

  • Factors such as remuneration and training and supervision must be considered.

  • An increased investment in mental health care is therefore essential.

Abstract

Task-sharing has frequently been proposed as a strategy to overcome human resource shortages in order to scale up mental health care. Although evidence suggests this approach is effective, to date no review has been conducted to assess its acceptability and feasibility among service users and health care practitioners. This review summarises current findings and provides evidence-based recommendations to improve the success and sustainability of task-sharing approaches. All study designs were included and both qualitative and quantitative data were extracted and reviewed using a comparative thematic analysis. In total, 21 studies were included, nine of which were of strong or adequate quality and twelve of unknown quality. The review highlighted that task-sharing is not an outright solution for overcoming human resource shortages in low and middle income countries. A number of factors need to be considered in order for task-sharing to be acceptable and feasible, for example the incidence of distress experienced by the task-sharing workforce, their self-perceived level of competence, the acceptance of the workforce by other health care professionals and the incentives provided to ensure workforce retention. As the main barrier to addressing these is a lack of resources, an increased investment in mental health care is essential in order to ensure that task-sharing interventions are successful and sustainable.

Introduction

According to the most recent WHO report, neuropsychiatric conditions contribute to approximately 14% of the global burden of disease (World Health Organisation, 2008). Furthermore there remains a substantial treatment gap, (Kohn, Saxena, Levav, & Saraceno, 2004) despite the existence of a wide range of treatments with proven effectiveness in low and middle income countries (LMIC) (Patel et al., 2007).

A major barrier to scaling up services is a shortage of human resources, for which task-sharing has been proposed as a strategy (Kakuma et al., 2011). Task-sharing is the process by which tasks are delegated to less specialised workers in order to use human resources more efficiently and increase capacity and health care coverage within a constrained budget. For mental health, non-specialist health and other workers have been trained to contribute to the detection, diagnosis, treatment, and prevention of various mental disorders (Kakuma et al., 2011). Preliminary results from a Cochrane review of the effectiveness of task-sharing interventions for mental health in LMIC have shown that individuals with no mental health background can deliver psychological treatments effectively with relatively little training and continued supervision (Van Ginneken et al., 2011, 2013).

To date no review has been conducted to assess the acceptability and feasibility of task-sharing mental health care. Feasibility may be challenged by factors such as time-constraints and number of workers available whilst the approach may not be acceptable to service users, carers and health care providers since mental health care is often complex and sensitive. This review summarises current findings and highlights barriers which tasking-sharing will need to overcome if it is to be scaled up as a strategy to reduce the treatment gap for mental disorders.

Section snippets

Methods

A full description of the methods is available in Supplementary File 1. In brief, five electronic databases were searched combining the concepts non-specialist workforce AND mental disorders AND LMIC and relevant organisations and experts were contacted. Titles and abstracts were screened and the full text copies of all potentially relevant studies examined to determine whether they met the pre-specified inclusion criteria. Both English language peer-reviewed and grey literature was included

Characteristics of included studies

A total of seventeen articles describing twenty-one studies met the eligibility criteria and were included in the review. Supplementary File 2 presents the flow chart for included studies and Supplementary File 3 provides full details of all included studies including a summary of their findings and quality assessment. Fifteen studies were published in peer-reviewed journals, while six were grey literature. Nearly all studies were conducted in either Africa or South Asia. The task-sharing

Discussion

This review aimed to explore the acceptability and feasibility of task-sharing interventions in LMIC through the experiences and perceptions of those involved. As a number of different factors affect the acceptability and feasibility of an intervention, it was not possible to distinguish whether some interventions were more acceptable or feasible than others. However synthesis of the available data allowed a number of broader conclusions regarding the characteristics of acceptable and feasible

Conclusion

Task-sharing has become a widely adopted strategy to scale-up mental health care in LMIC following a number of large trials demonstrating its effectiveness. However to date little emphasis has been placed on evaluating the acceptability and feasibility of these interventions. This review illustrates the complexity of both acceptability and feasibility and the importance of exploring them in depth. It concludes that task-sharing is not an outright solution for shortages of mental health

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