The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: A systematic review

Acceptability and feasibility of using non-specialist health workers to deliver mental health care: Stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda

“…First, our analysis of stakeholder perceptions suggest that the following conditions are important basic requirements for task-sharing across contexts: increased numbers of human resources and improved access to medications; adequate training, support, and compensation for health workers who take on new mental health tasks; and ongoing structured supportive supervision at community and primary health care levels. Second, our data build upon previous studies (Padmanathan and DeSilva, 2013) that emphasize systemic issues as fundamental barriers to task-sharing, including overburdening health workers, adequate training and supervision, remuneration, and integration of mental health care tasks into existing health systems. Finally, stakeholders illuminated meaningful contextual differences that shape the acceptability and feasibility of task-sharing and bring to light considerable gaps in discourse around task-sharing mental health care that warrant attention.…”

“…The first paper suggests three essential components: 1) contextually specific research to determine how and what task-sharing framework is suitable in light of local resource constraints and health care delivery systems; 2) training and a strong supportive supervisory framework for non-specialists; and 3) sufficient specialists who can provide the necessary referral support (Petersen et al., 2011). Second, a recent systematic review including 21 qualitative studies found task-sharing mental health services in LMICs was largely considered acceptable and feasible by service users as well as health care providers (Padmanathan and DeSilva, 2013). However, important limiting factors emerged that require further investigation, including context-dependent variation in participants' satisfaction with having mental health needs met, the importance of the personal characteristics of non-specialist workers such as gender, age, training, and their role in the community; concern that lack of supervision for health personnel may result in psychological distress; logistical barriers such as transport, private spaces for meeting, restrictions on who can prescribe psychotropic medications, and funding for health worker training; and issues around compensation, support, and clearly delineated roles for health care providers.…”

The effect of mutual task sharing on the number of needed health workers at the Iranian Health Posts; Does task sharing increase efficiency?

“…On the other hand, changing the role of ANM from a midwife whose main job was to deliver babies and maternal and child healthcare, to a paramedical whose activities are limited to family planning, immunization and superficial antenatal care, has been criticized because of decreasing performance of ANM and insufficient maternal mortality in India (18). Therefore despite of emphasizing on shifting tasks from midwives to other health workers in order to access (5), the quality of care, feasibility and acceptability also should be considered (7,11). Our study also emphasizes on considering the contextual conditions to judge about efficiency in task sharing.…”

Integration of mental health into primary healthcare in low-income countries: Avoiding medicalization

“…Task shifting is being used in many lowincome countries (de Jong, 1996;Murthy, 2011), for example, in Ethiopia nurses were trained for a much wider range of extended roles in rural districts, from prescription of drugs to community mental health education (Araya et al, 2009). However, the outcomes of task shifting in mental healthcare have not been well established, and it is unclear how feasible it would be outside pilot projects (Padmanathan & De Silva, 2013). Non-specialized health workers, such as nurses, midwives and community health workers, may also be reluctant to engage in mental health activities when their roles and workloads historically did not include such activities.…”