Were missed or remained unexplored by study authors. In our discussion of findings we pointed to areas for further inquiry that may allow for discerning additional opinions and experiences. Reviewer bias The first-named author conducted the literature search, but the criteria for selection were chosen by both the first and second authors. In addition, while the analysis of the literature and subsequent synthesis statements were produced by the first two authors, the third author provided a thorough check of methods and conclusions. In this way, the potential for reviewer bias was reduced. The first and third named authors are paediatricians with interests in neonatal care. Such experience may have resulted in a bias towards clinician perspectives. Both the second and third named authors are members of the HSD-N project, and they may have been influenced by this association.ConclusionTask-shifting interventions in sub-Saharan Africa have expanded far beyond the HIV sector for which they were initially developed. Although most of the evidence around taskshifting interventions is quantitative, a growing number of qualitative studies is emerging from sub-Saharan Africa. Qualitative studies suggest that task-shifting interventions may carry important short-term and long-term implications for all cadres of health workers. Findings in this review are based on a small number of relatively short studies with several methodological limitations. Based on the data available, it appears that task shifting may negatively impact health workers’ sense of agency and ability to perform their work if not carefully designed. Established health professionals have been concerned that task shifting is diminishing their role in the health system. Lower cadres assuming new tasks appear to be highly order ML390 motivated to meet workplace demands and provide patient care. However, assuming new tasks may be occurring at the expense of high work burden, performing tasks beyond one’s scope of practice and potentially compromising patient ML390 chemical information safety. Task-shifting programmes have often been perceived as cost-saving interventions, but this may have contributed to unacceptably low remuneration and career progression options for health workers, especially in rural areas. On a positive note, some task-shifting interventions appeared to have resulted in improved communication within health teams and enabled a more rational distributionof work, especially when administrative tasks were being delegated. Some of the areas warranting further qualitative inquiry include opportunity cost of task shifting for health workers, patients’ experiences with task-shifting interventions and patient’s safety. Many limitations of task-shifting programmes arise from limitations inherent to weak, poorly resourced health systems in sub-Saharan Africa. We acknowledge that the certainty and transferability of our literature review findings are limited by the number of qualitative studies available and methodological shortcomings of individual studies. Nevertheless, literature review allowed us to examine first-hand experiences and challenges arising from the field and thus complemented more general recommendations and guidelines set by the WHO and other organisations. As mentioned in the abstract, in addition to informing a broad audience of policy makers, this review aims to provide practical guidance to an ongoing project in Kenya. Task shifting as a potential intervention in Nairobi’s neonatal nurseries s.Were missed or remained unexplored by study authors. In our discussion of findings we pointed to areas for further inquiry that may allow for discerning additional opinions and experiences. Reviewer bias The first-named author conducted the literature search, but the criteria for selection were chosen by both the first and second authors. In addition, while the analysis of the literature and subsequent synthesis statements were produced by the first two authors, the third author provided a thorough check of methods and conclusions. In this way, the potential for reviewer bias was reduced. The first and third named authors are paediatricians with interests in neonatal care. Such experience may have resulted in a bias towards clinician perspectives. Both the second and third named authors are members of the HSD-N project, and they may have been influenced by this association.ConclusionTask-shifting interventions in sub-Saharan Africa have expanded far beyond the HIV sector for which they were initially developed. Although most of the evidence around taskshifting interventions is quantitative, a growing number of qualitative studies is emerging from sub-Saharan Africa. Qualitative studies suggest that task-shifting interventions may carry important short-term and long-term implications for all cadres of health workers. Findings in this review are based on a small number of relatively short studies with several methodological limitations. Based on the data available, it appears that task shifting may negatively impact health workers’ sense of agency and ability to perform their work if not carefully designed. Established health professionals have been concerned that task shifting is diminishing their role in the health system. Lower cadres assuming new tasks appear to be highly motivated to meet workplace demands and provide patient care. However, assuming new tasks may be occurring at the expense of high work burden, performing tasks beyond one’s scope of practice and potentially compromising patient safety. Task-shifting programmes have often been perceived as cost-saving interventions, but this may have contributed to unacceptably low remuneration and career progression options for health workers, especially in rural areas. On a positive note, some task-shifting interventions appeared to have resulted in improved communication within health teams and enabled a more rational distributionof work, especially when administrative tasks were being delegated. Some of the areas warranting further qualitative inquiry include opportunity cost of task shifting for health workers, patients’ experiences with task-shifting interventions and patient’s safety. Many limitations of task-shifting programmes arise from limitations inherent to weak, poorly resourced health systems in sub-Saharan Africa. We acknowledge that the certainty and transferability of our literature review findings are limited by the number of qualitative studies available and methodological shortcomings of individual studies. Nevertheless, literature review allowed us to examine first-hand experiences and challenges arising from the field and thus complemented more general recommendations and guidelines set by the WHO and other organisations. As mentioned in the abstract, in addition to informing a broad audience of policy makers, this review aims to provide practical guidance to an ongoing project in Kenya. Task shifting as a potential intervention in Nairobi’s neonatal nurseries s.
