The SHIFT-SHARE framework: Transforming tomorrow’s healthcare workforce through strategic task shifting and sharing

In response to the global workforce crisis, projected to reach up to 18 million providers by 2035, task shifting and task sharing (TS/S) are emerging as efficient strategies to optimise existing human resources in healthcare and ensure that services remain accessible and cost-effective. TS/S redistribute services from providers with higher skills-base to providers typically with fewer qualifications through organised competency-based skilling. Results from our global bibliographic analysis, spanning from 1970s to the present, affirms the significance of TS/S in healthcare and underscores its enduring relevance across contexts with varying income levels and disease conditions, including HIV care, mental health services, tuberculosis management and many more. A subsequent scoping review (Das et al, 2023) demonstrated the adaptability of TS/S during the COVID-19 pandemic and how it assisted in bridging acute service gaps globally. The WHO’s “Global recommendations and guidelines” on task shifting (WHO, 2008) recommended that countries establish regulatory and implementation frameworks to expand TS/S in addressing public health issues. Despite this advice, implementation-focused frameworks for TS/S are lacking.
Implementation frameworks can offer conceptual roadmaps to administer change and navigate the complex processes of services delivery. We present our approach to constructing a new implementation framework for TS/S and the research being undertaken to evaluate its validity, applicability and real-world utility. Named as the ‘Strategic Healthcare Implementation Framework for Task Shifting, Sharing and Resource Enhancement’ or the SHIFT-SHARE model, it has been conceptualised to offer stepwise guidance on how to operationalise TS/S. The model has six cyclical phases, namely 1) ‘Environmental scanning’, 2) ‘Priming’, 3) ‘Risk signal’, 4) ‘Capacity building’, 5) ‘Monitoring and evaluation’, and 6) ‘Maintenance and diffusion’. Clinical safety, patient-centredness, ethical considerations and stakeholder feedback underpin each stage of our framework. SHIFT-SHARE serves as a template to design and execute TS/S-based care. It can help appraise system and workforce organisations, enablers and hinderers, stakeholder perspectives, local contexts and determinants. It can assist in standardising processes, ensure adherence to best practices and can help replicate, scale or even adapt TS/S to specific contexts. It can also aid research by providing foundations to study movement of services between cadres and bring much-needed consistency in the language used to define goals, processes or report outcomes. such that it encourages agreement and collaboration on TS/S, even beyond academia.
These framework attributes make it a strong instrument for enhancing the efficiency, quality and cost- effectiveness of shifting and sharing of healthcare services between different cadres of providers. We invite conference attendees to explore our framework and share their valuable insights, contributing to the ongoing discourse on its application and potential enhancements.