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Task-shifting for cardiovascular risk factor management: lessons from the Global Alliance for Chronic Diseases
  1. Rohina Joshi1,
  2. Amanda G Thrift2,
  3. Carter Smith3,4,
  4. Devarsetty Praveen5,
  5. Rajesh Vedanthan6,
  6. Joyce Gyamfi6,
  7. Jon-David Schwalm7,
  8. Felix Limbani8,
  9. Adolfo Rubinstein9,
  10. Gary Parker10,
  11. Olugbenga Ogedegbe6,
  12. Jacob Plange-Rhule11,
  13. Michaela A Riddell12,
  14. Kavumpurathu R Thankappan13,
  15. Margaret Thorogood14,
  16. Jane Goudge9,
  17. Karen E Yeates3,15
  1. 1 The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
  2. 2 Stroke and Ageing Research Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
  3. 3 Department of Medicine, Queen’s University, Kingston, Ontario, Canada
  4. 4 Department of Psychology, Queen’s University, Kingston, Ontario, Canada
  5. 5 The George Institute for Global Health, Hyderabad, India
  6. 6 Department of Population Health, New York University School of Medicine, New York City, New York, USA
  7. 7 Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  8. 8 Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
  9. 9 Minister of Health, Buenos Aires, Argentina
  10. 10 Institute for Global Health, University College London, London, UK
  11. 11 Department of Medicine, Komfo Anokye Teachings Hospital, Kumasi, Ghana
  12. 12 Monash University, Clayton, Victoria, Australia
  13. 13 Achutha Menon Centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
  14. 14 Warwick Medical School, University of Warwick, Coventry, UK
  15. 15 Department of Global Health, College of Global Public Health, New York University, New York City, New York, USA
  1. Correspondence to Dr Rohina Joshi; rjoshi{at}georgeinstitute.org.au

Abstract

Task-shifting to non-physician health workers (NPHWs) has been an effective model for managing infectious diseases and improving maternal and child health. There is inadequate evidence to show the effectiveness of NPHWs to manage cardiovascular diseases (CVDs). In 2012, the Global Alliance for Chronic Diseases funded eight studies which focused on task-shifting to NPHWs for the management of hypertension. We report the lessons learnt from the field. From each of the studies, we obtained information on the types of tasks shifted, the professional level from which the task was shifted, the training provided and the challenges faced. Additionally, we collected more granular data on ‘lessons learnt ’ throughout the implementation process and ‘design to implementation’ changes that emerged in each project. The tasks shifted to NPHWs included screening of individuals, referral to physicians for diagnosis and management, patient education for lifestyle improvement, follow-up and reminders for medication adherence and appointments. In four studies, tasks were shifted from physicians to NPHWs and in four studies tasks were shared between two different levels of NPHWs. Training programmes ranged between 3 and 7 days with regular refresher training. Two studies used clinical decision support tools and mobile health components. Challenges faced included system level barriers such as inability to prescribe medicines, varying skill sets of NPHWs, high workload and staff turnover. With the acute shortage of the health workforce in low-income and middle-income countries (LMICs), achieving better health outcomes for the prevention and control of CVD is a major challenge. Task-shifting or sharing provides a practical model for the management of CVD in LMICs.

  • implementation science
  • task shifting
  • cardiovascular disease
  • hypertension
  • non-communicable diseases

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjgh-2018-001092

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors The paper was drafted by RJ and KEY. All the coauthors provided case summaries for their studies, contributed towards the drafts and approved the final manuscript.

    • Funding RJ is funded by a Future Leader Fellowship by the Australian National Heart Foundation. AGT received fellowship support from NHMRC (1042600). Funding for the studies described was provided by the following GACD Hypertension Program funding agencies: Canadian Institutes of Health Research (Grant No. 120389); Grand Challenges Canada (Grant Nos. 0069-04 and 0070-04); International Development Research Centre; Canadian Stroke Network; Australian National Health and Medical Research Council (Grant Nos. ID 1040147 and 104018); the US National Institutes of Health (National Heart, Lung and Blood Institute and National Institute of Neurological Disorders and Stroke) (Grant Nos. U01 HL114200, U01 NS079179 and U01 HL114180); the United Kingdom Medical Research Council (Grant Nos. APP 1040179, APP 1041052 and J01 60201); the Malaysian Ministry of Higher Education (Long-term Research Grants Scheme) and the South African Medical Research Council.

    • Disclaimer This report does not represent the official view of the National Institute of Neurological Disorders and Stroke, the National Institutes of Health or any part of the US Federal Government. No official support or endorsement of this article by the National Institutes of Health is intended or should be inferred.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.