An overview of reviews: what do we know about task shifting and skill mix change in healthcare?

Task shifting is a globally recognized strategy to respond to healthcare challenges (WHO, 2008; Simms et al., 2019). This research contributes to the academic debate on task shifting by providing a comprehensive overview of the current knowledge and interpreting the results through the theoretical framework by Sibbald et al. (2004), describing task shifting as enhancement (extending roles of a workers group); substitution/delegation (exchanging tasks between groups of workers); innovation (creating new jobs by introducing new skills or technological innovation). The study is a systematic review of reviews (Smith et al., 2011). The search was performed on Scopus, completed in February 2023, confined to English published article reviews, from 2004 onwards, coherently with publication year of Sibbald et al. (2004). The search keywords defined: type of publication (review), health personnel (doctor/physician, nurse, technician, therapist, social/community worker) and focus of the article (task shifting or skill mix). Of the 692 publications identified, 37 met the inclusion criteria: 23 systematic reviews, 8 non-systematic/narrative, 3 scoping and 3 meta-analyses. In total, 815 papers are reviewed by the studies. 19 are focused on developing countries, 2 on developed and 16 do not specify it. 8 are focused on non-communicable diseases, 7 on surgery/acute care, 6 on HIV, 6 on primary care, 10 studies do not indicate it. Task shifting is not only of doctors and nurses: mental health specialists, surgeons, general practitioners, midwives, technicians, therapists, community workers, volunteers are examples of professionals considered. 31 reviews conceive task shifting as substitution; 4 as enhancement; 1 as innovation. Task shifting is mostly intended as tasks exchange from qualified to less-qualified workers, mainly to respond to staff shortages. It can be performed by different categories of professionals, being applicable to different contexts, services and treatments. KEY MESSAGES: • Task shifting is a globally recognized strategy to respond to healthcare challenges. This research contributes to the academic providing a comprehensive overview of the current knowledge on the topic. • Task shifting can be performed by different categories of professionals, being applicable to many care services. It should be designed according to the specific context and professionals involved.