Global surgical and anaesthetic task shifting: a systematic literature review and survey

Evaluation of a surgical training programme for clinical officers in Malawi

“…Two follow‐up cohorts of COs have already entered Malawi's national BSc in Surgery programme developed by COST‐Africa. This is an important achievement in terms of sustainable solutions to remedy the health workforce crisis that deprives rural populations of critical life‐saving surgical care, in Malawi and other countries in the sub‐Saharan Africa region.…”

“…In sub‐Saharan Africa, in particular, one of the main issues is the shortage of specialist surgeons at the district level, which means that the needs of rural dwellers go unmet. One response has been to task‐shift basic essential surgery from surgical specialists to less specialized cadres of clinicians. Malawi is one such country where most surgical, obstetric and orthopaedic procedures are done by clinical officers (COs).…”

“…COs are a cadre of non‐physician clinicians who receive 3 years of basic training on how to diagnose and treat common conditions. Elsewhere, they are also known as associate clinicians and non‐surgeons. Task‐shifting of major surgery for common conditions to non‐physician clinicians has taken place in between 30 and 41 LMICs.…”

Population-level scale-up of surgery platforms for women’s cancer care in low- and middle-income countries

“…Women's cancer surgical specialists at district hospitals would be directly supported by cadres of less specialized physicians (e.g., family physicians or 'general medical officers') or physician assistants (e.g., clinical officers, licentiates) to whom well-defined clinical tasks can be redistributed, according to specific national/regional regulations and local contextual necessities [15][16][17]. Although nurses are typically not licensed to undertake surgical procedures in these settings, context specific adaptations may allow them to provide front-line surgical care for relatively low-risk surgery (e.g., biopsy of lower female genital tract lesions including loop electrosurgical excision of the cervix, biopsy of the vulva, endometrial biopsy, ultrasound-guided biopsy of palpable breast masses) after adequate training and under constant supervision.…”

An integrated approach to surgery and primary care systems strengthening in low- and middle-income countries: Building a platform to deliver across the spectrum of disease

“…[22][23][24][25] To expand access to surgical care, many countries in both high-and low-income settings have taken this a step further by employing task shifting or task sharing, by training either general practitioners or nonphysician providers to treat certain surgical conditions. 26 The World Health Organization has endorsed task shifting for expansion of access to human immunodeficiency virus and obstetric care, and the Bellagio Essential Surgery Group documented task shifting as a mechanism for workforce expansion. [27][28][29] Building high-quality front-line capacity for diagnosis and basic treatment in the primary care system requires investments not only in initial training, but also in programs of sustained mentorship and posttraining support and supervision.…”