BackgroundHealth workforce needs-based shortages and skill mix imbalances are significant health workforce challenges. Task shifting, defined as delegating tasks to existing or new cadres with either less training or narrowly tailored training, is a potential strategy to address these challenges. This study uses an economics perspective to review the skill mix literature to determine its strength of the evidence, identify gaps in the evidence, and to propose a research agenda.MethodsStudies primarily from low-income countries published between 2006 and September 2010 were found using Google Scholar and PubMed. Keywords included terms such as skill mix, task shifting, assistant medical officer, assistant clinical officer, assistant nurse, assistant pharmacist, and community health worker. Thirty-one studies were selected to analyze, based on the strength of evidence.ResultsFirst, the studies provide substantial evidence that task shifting is an important policy option to help alleviate workforce shortages and skill mix imbalances. For example, in Mozambique, surgically trained assistant medical officers, who were the key providers in district hospitals, produced similar patient outcomes at a significantly lower cost as compared to physician obstetricians and gynaecologists. Second, although task shifting is promising, it can present its own challenges. For example, a study analyzing task shifting in HIV/AIDS in sub-Saharan Africa noted quality and safety concerns, professional and institutional resistance, and the need to sustain motivation and performance. Third, most task shifting studies compare the results of the new cadre with the traditional cadre. Studies also need to compare the new cadre's results to the results from the care that would have been provided--if any care at all--had task shifting not occurred.ConclusionsTask shifting is a promising policy option to increase the productive efficiency of the delivery of health care services, increasing the number of services provided at a given quality and cost. Future studies should examine the development of new professional cadres that evolve with technology and country-specific labour markets. To strengthen the evidence, skill mix changes need to be evaluated with a rigorous research design to estimate the effect on patient health outcomes, quality of care, and costs.

There was an evidence for the correlation between social capital and depression in older Chinese and Korean immigrant population. It suggests the needs to develop social programs and service in order to build more social capital for older immigrants.

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Korea's nonprofit sector has undergone a sudden expansion in the last decade and its nonprofits experienced high employee turnover. This study is the first in Korean literature to examine workforce shifts in nonprofit organizations and explore influential factors that explain job changes from the nonprofit sector to other sectors. Using a three-wave panel data set of community college/university graduates, the Graduates Occupational Mobility Survey, we conducted a discrete-time survival analysis with the dependent variable of actual turnover. Our findings indicate that over half of employees left nonprofits within a year, and the majority found a new job in for-profit organizations. Different factors predicted turnover to for-profits, government agencies, and educational or research institutes. Age, wage level, employment type, and the size of nonprofit organizations explained employee shifts. Satisfaction with one's overall job, job content, social reputation, and opportunities for career development were significant predictors. Implications for nonprofit organizations are discussed.

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