Exploring the effects of task shifting for HIV through a systems thinking lens: the case of Burkina Faso

BMC Public Health

Taghreed Adam³  Sennen Hounton²  Bocar Kouyaté⁵  Seni Kouanda¹  Fadima Yaya Bocoum⁴ 

[1] Département biomédical et santé publique, Institut de Recherche en Science de la Santé, Ouagadougou, Burkina Faso;Technical Division, United Nations Population Fund, New-York, USA;Alliance for Health Policy and Systems Research, World Health Organization, Geneva 1211, Switzerland;University of Western Cape, School of Public Health, Cape Town, South Africa;Ministry of Health, Ouagadougou, Burkina Faso

关键词: System-wide impact;    Health systems research;    Systems thinking;    Evaluation;    Task delegation;    Task shifting;   

Others  :  1161625
DOI  :  10.1186/1471-2458-13-997

 received in 2013-05-15, accepted in 2013-10-16,  发布年份 2013

【 摘 要 】

Background

While the impact of task shifting on quality of care and clinical outcomes has been demonstrated in several studies, evidence on its impact on the health system as a whole is limited. This study has two main objectives. The first is to conceptualize the wider range of effects of task shifting through a systems thinking lens. The second is to explore these effects using task shifting for HIV in Burkina Faso as a case study.

Methods

We used a case study approach, using qualitative research methods. Data sources included document reviews, reviews of available data and records, as well as interviews with key informants and health workers.

Results

In addition to the traditional measures of impact of task shifting on health outcomes, our study identified 20 possible effects of the strategy on the system as a whole. Moreover, our analysis highlighted the importance of differentiating between two types of health systems effects. The first are effects inherent to the task shifting strategy itself, such as job satisfaction or better access to health services. The second are effects due to health system barriers, for example the unavailability of medicines and supplies, generating a series of effects on the various components of the health system, e.g., staff frustration.

Among the health systems effects that we found are positive, mostly unintended, effects and synergies such as increased health workers' sense of responsibility and worthiness, increased satisfaction due to using the newly acquired skills in other non-HIV tasks, as well as improved patient-provider relationships. Among the negative unintended effects are staff frustration due to lack of medicines and supplies or lack of the necessary infrastructure to be able to perform the new tasks.

Conclusion

Our analysis highlights the importance of adopting a systems thinking approach in designing, implementing and evaluating health policies to mitigate some of the design issues or system bottle-necks that may impede their successful implementation or risk to present an incomplete or misleading picture of their impact.

【 授权许可】

   
2013 Yaya Bocoum et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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