Task-shifting and system readiness: a narrative review of strategies for pediatric emergency care in low-resource settings

Abstract

Background: In various low- and middle-income countries (LMICs), non-specialist healthcare providers (HCPs), such as general practitioners, nurses, and community health workers (CHWs), often manage acute pediatric emergencies. HCPs in these settings may face challenges due to limited training in emergency care and a lack of ongoing educational opportunities. Additionally, they often operate in clinical environments that lack dedicated emergency departments (EDs), child-specific care protocols, or the necessary pediatric equipment required for managing critically ill children. This is concerning, considering that acute illnesses and injuries are significant contributors to the high rates of preventable childhood deaths in low-and middle-income countries.

Objective: This review synthesizes evidence on pediatric emergency care strategies to improve fidelity to evidence-based practice that can be utilized and scaled beyond the conventional ED framework, without relying on Pediatric Emergency Medicine (PEM)-trained personnel, who may be unavailable in these regions. This includes task shifting, where community and non-physician HCPs learn how to provide emergency triage and acute lifesaving interventions for children in preventing morbidity and mortality, and other strategies, framed within the established concept of "pediatric readiness", which is a systems-based approach encompassing staff competencies, protocols, equipment, and quality improvement. Additionally, this review explores practical examples from international real-world applications of such strategies.

Methods: A narrative review of literature from 2000 to 2024 covering task-shifting, protocols, simulation training, and system approaches for pediatric emergency care in low-resource settings.

Results: Our synthesis of the literature suggests that low-dose, low-fidelity simulation-based training can effectively enhance confidence and competence in pediatric resuscitation. By recognizing the roles of community-based and non-specialist providers within a pediatric readiness framework, standardizing relevant protocols, and providing appropriate tools and education, we can substantially improve pediatric emergency care systems on a broader scale.

Conclusion: This review offers valuable insights for clinicians and policymakers dedicated to reducing preventable pediatric mortality in low-resource settings.

Keywords: Emergency triage assessment and treatment (ETAT); Global health; Low-resource settings; Mortality reduction; Pediatric emergency care; Task-shifting.

Fig. 1

Pediatric emergency flowchart for frontline providers in low-resource settings. Original figure by the authors, based on clinical principles from guidelines (WHO ETAT, IMCI, or BEC) [30, 31, 41]

Fig. 2

Managing airway emergencies. Original figure by the authors, based on clinical principles from guidelines (WHO ETAT, IMCI, or BEC) [30, 31, 41]

Fig. 3

Dehydration assessment. Original figure by the authors, based on clinical principles from guidelines (WHO ETAT, IMCI, or BEC) [30, 31, 41]

Fig. 4

Initial management and recognition of sepsis. Original figure by the authors, based on clinical principles from guidelines (WHO ETAT, IMCI, or BEC) [30, 31, 41]