Ernments can ill afford to miss opportunities to provide better care

Ernments can ill afford to miss opportunities to provide better care to newborns. Millennium Development Goal 4 (MDG4) aimed to reduce the 1990 under-five mortality rate by two-thirds before 2015. Kenya is one of a majority of sub-Saharan African countries that have failed to reduce overall child mortality in line with MDG4. This disappointing result can be directly linked with the failure to reduce DuvoglustatMedChemExpress Duvoglustat neonatal mortality, with absolute rates in many African and South Asian countries at least 10 higher than in developed countries. Consequently, neonatal mortality now accounts for over 40 of all child deaths in many of these countries (Lawn et al. 2014). Recent research suggests that although the provision of rural healthcare interventions is an important part of reducing neonatal mortality, inpatient neonatal care is also a major contributing factor and should be targeted (Moxon et al. 2015). Globally, however, addressing issues relating to human resources for health and health financing have been identified as the most significant bottlenecks in the care of small and sick newborns (Moxon et al. 2015). At the intersection of human resource solutions that might improve both access and cost containment lies task shifting. Task-shifting interventions should improve, rather than reduce, quality of care. In addition, we note that they are not simply technical solutions to fill service gaps, but instead a complex intervention with potentially wide effects on the health system. Given these realities, we undertook a review to provide clear and practical guidance by analysing literature covering task-shifting projects in sub-Saharan Africa to inform the design of possible task-shifting solutions in neonatal care in Kenya and other low-income countries.Task shifting in sub-Saharan AfricaWe will use the World Health Organization (WHO) definition of task shifting. This is, `the rational redistribution of tasks among health workforce teams’, wherein `specific tasks are moved, where appropriate, from highly qualified health workers to health workers with shorter training?2016 The Authors. Journal of Clinical Nursing Published by John Wiley Sons Ltd. Journal of Clinical Nursing, 25, 2083?ReviewReview: Task shifting in sub-Saharan Africaand fewer qualifications in order to make more efficient use of the available human resources for health’ (WHO 2008). Task-shifting interventions have a long history in subSaharan Africa spanning nonphysician clinicians to community health workers, but gained prominence as a way to scale up and decentralise HIV care (WHO 2008) with growing importance in other specific service areas such as emergency obstetric surgery (Gessessew et al. 2011) and mental health (Bhana et al. 2010). The principle of delegating tasks itself is, of course, not new. Task shifting has been occurring informally in response to shortage of human resources across various settings, be it an epidemic outbreak or an ongoing coping mechanism at an understaffed health facility (1-Deoxynojirimycin web Lehmann et al. 2009). That task-shifting results in no diminution of quality while improving access is supported by a number of systematic reviews and meta-analyses. Quality of HIV care provided by adequately trained and supported nurses is comparable to the quality of care provided by physicians (Kredo et al. 2014). Nonphysician health workers can effectively manage noncommunicable diseases in the community, although authors of the review pointed out that further research is need.Ernments can ill afford to miss opportunities to provide better care to newborns. Millennium Development Goal 4 (MDG4) aimed to reduce the 1990 under-five mortality rate by two-thirds before 2015. Kenya is one of a majority of sub-Saharan African countries that have failed to reduce overall child mortality in line with MDG4. This disappointing result can be directly linked with the failure to reduce neonatal mortality, with absolute rates in many African and South Asian countries at least 10 higher than in developed countries. Consequently, neonatal mortality now accounts for over 40 of all child deaths in many of these countries (Lawn et al. 2014). Recent research suggests that although the provision of rural healthcare interventions is an important part of reducing neonatal mortality, inpatient neonatal care is also a major contributing factor and should be targeted (Moxon et al. 2015). Globally, however, addressing issues relating to human resources for health and health financing have been identified as the most significant bottlenecks in the care of small and sick newborns (Moxon et al. 2015). At the intersection of human resource solutions that might improve both access and cost containment lies task shifting. Task-shifting interventions should improve, rather than reduce, quality of care. In addition, we note that they are not simply technical solutions to fill service gaps, but instead a complex intervention with potentially wide effects on the health system. Given these realities, we undertook a review to provide clear and practical guidance by analysing literature covering task-shifting projects in sub-Saharan Africa to inform the design of possible task-shifting solutions in neonatal care in Kenya and other low-income countries.Task shifting in sub-Saharan AfricaWe will use the World Health Organization (WHO) definition of task shifting. This is, `the rational redistribution of tasks among health workforce teams’, wherein `specific tasks are moved, where appropriate, from highly qualified health workers to health workers with shorter training?2016 The Authors. Journal of Clinical Nursing Published by John Wiley Sons Ltd. Journal of Clinical Nursing, 25, 2083?ReviewReview: Task shifting in sub-Saharan Africaand fewer qualifications in order to make more efficient use of the available human resources for health’ (WHO 2008). Task-shifting interventions have a long history in subSaharan Africa spanning nonphysician clinicians to community health workers, but gained prominence as a way to scale up and decentralise HIV care (WHO 2008) with growing importance in other specific service areas such as emergency obstetric surgery (Gessessew et al. 2011) and mental health (Bhana et al. 2010). The principle of delegating tasks itself is, of course, not new. Task shifting has been occurring informally in response to shortage of human resources across various settings, be it an epidemic outbreak or an ongoing coping mechanism at an understaffed health facility (Lehmann et al. 2009). That task-shifting results in no diminution of quality while improving access is supported by a number of systematic reviews and meta-analyses. Quality of HIV care provided by adequately trained and supported nurses is comparable to the quality of care provided by physicians (Kredo et al. 2014). Nonphysician health workers can effectively manage noncommunicable diseases in the community, although authors of the review pointed out that further research is need.

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