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. 2023 May 5;23(1):446.
doi: 10.1186/s12913-023-09416-5.

Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review

Ikechi G Okpechi  1   2 , Ijezie I Chukwuonye  3 , Udeme Ekrikpo  4 , Jean Jacques Noubiap  5 , Yemi R Raji  6 , Yusuf Adeshina  7 , Samuel Ajayi  8   6 , Zunaid Barday  8 , Malini Chetty  8 , Bianca Davidson  8 , Emmanuel Effa  9   10 , Stephen Fagbemi  11 , Cindy George  12 , Andre P Kengne  12 , Erika S W Jones  8 , Hamidu Liman  7 , Mohammad Makusidi  7 , Hadiza Muhammad  7 , Ikechukwu Mbah  13 , Kwazi Ndlovu  8 , Grace Ngaruiya  14 , Chimezie Okwuonu  3 , Ugochi Samuel-Okpechi  15 , Elliot K Tannor  16 , Ifeoma Ulasi  17 , Zulkifilu Umar  11 , Nicola Wearne  8 , Aminu K Bello  18
Affiliations

Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review

Ikechi G Okpechi et al. BMC Health Serv Res. .

Abstract

Background: Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations.

Methods: We conducted this scoping review to answer the question: "what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?" Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively.

Results: Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively.

Conclusion: Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined.

Keywords: Africa; Cardiovascular disease; Chronic kidney disease; Diabetes; Health workforce; Hypertension; Task shifting.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
PRISMA Flow Diagram for study selection
Fig. 2
Fig. 2
Map of Africa showing included countries, number of studies and sample size per country. (Created using: www.mapchart.net)
Fig. 3
Fig. 3
Relationship between task shifting and clinical outcomes. Abbreviations: CHW – community health workers *Others include health promoters, medicine counter assistant, non-physician clinician
See this image and copyright information in PMC

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