Table 7 Selected WHO Global Recommendations for Task Shifting and related study operationalization

Endeavor to identify and involve appropriate stakeholders concerning aspects of task shifting approach (#2)

Study examined perceptions of both types of providers, including use of experience from a pilot test regarding acceptability among women.

Examine extent to which task shifting is already taking place (#4)

Study found that informal task shifting occurred primarily in absence of skilled provider and that lay nurse aides regretted lack of training. Only a small proportion of counseling was provided by lay nurse aides prior to the shift.

Adapt or create quality assurance mechanisms to support a task shifting approach that include processes and activities to monitor and improve quality of services. (#7)

The task shifting approach was adopted within a quality improvement collaborative that identifies improvement objectives and integrates site-level monitoring, coaching, and assessment of key indicators related to maternal and newborn care. Findings on effectiveness of tested changes are shared within learning sessions.

Define role and quality standards that serve as the basis for establishing recruitment, training and evaluation criteria. (#8)

Lay nurse aides were trained and evaluated based on recommended communication goals during antenatal care for pregnant women. Lay nurse aides were recruited as candidates for the task shift given their existing integration within health system and local community.

Provide supportive supervision and clinical mentoring within function of health teams that make certain that supervision staff have appropriate supervisory skills. (#11)

Task shifting approach included capacity building of nurse-midwives in supervision with emphasis on observation and feedback. Mentoring and supervision teams included technical personnel and regional trainers.

Recognize that sustainable expansion of essential health services cannot not rely on volunteer cadre. Rather, trained workers should receive adequate wages or commensurate incentives. (#14)

Lay nurse aides are paid government health staff whose wages are lower than those of nurses-midwives. Lay nurse aides reported several non-monetary incentives resulting from task shift, but efforts are needed to explore appropriate remuneration for expanded role.