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Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries

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Seidman, Gabriel, Atun, Rifat·2017·Human Resources for Health

DOI 10.1186/s12960-017-0200-9PMC PMC5390445

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Abstract

BACKGROUND: Task shifting has become an increasingly popular way to increase access to health services, especially in low-resource settings. Research has demonstrated that task shifting, including the use of community health workers (CHWs) to deliver care, can improve population health. This systematic review investigates whether task shifting in low-income and middle-income countries (LMICs) results in efficiency improvements by achieving cost savings. METHODS: Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL, and the Health Economic Evaluation Database on March 22, 2016. We included any original peer-review articles that demonstrated cost impact of a task shifting program in an LMIC. RESULTS: We identified 794 articles, of which 34 were included in our study. We found that substantial evidence exists for achieving cost savings and efficiency improvements from task shifting activities related to tuberculosis and HIV/AIDS, and additional evidence exists for the potential to achieve cost savings from activities related to malaria, NCDs, NTDs, childhood illness, and other disease areas, especially at the primary health care and community levels. CONCLUSIONS: Task shifting presents a viable option for health system cost savings in LMICs. Going forward, program planners should carefully consider whether task shifting can improve population health and health systems efficiency in their countries, and researchers should investigate whether task shifting can also achieve cost savings for activities related to emerging global health priorities and health systems strengthening activities such as supply chain management or monitoring and evaluation.

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See all 231

Authors: Seidman, G., & Atun, R.
Affiliations: Harvard University (US)
Corresponding author: Seidman, Gabriel
ORCID: Seidman, Gabriel
Atun, Rifat
Venue: Human Resources for Health
Publisher: Springer Science and Business Media LLC
Published: 2017-04-13
Volume: 15
Issue: 1
Pages: 29-29
ISSN: 1478-4491 (ISSN-L)
DOI: 10.1186/s12960-017-0200-9
PMC: PMC5390445
OpenAlex: W2606326829
Cited by: 231
References: 73
Citations by year: 2026: 23 · 2025: 21 · 2024: 30 · 2023: 30 · 2022: 26 · 2021: 28 · 2020: 34 · 2019: 20 · 2018: 15 · 2017: 4
FWCI: 5.31
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: Human Resources for Health (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Harvard Ministerial Leadership Program
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health Workforce Issues
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Practices
Keywords: task shifting, community health workers, health system efficiency, cost reduction, low- and middle-income countries, tuberculosis, HIV/AIDS, malaria, non-communicable diseases, neglected tropical diseases, childhood diseases, primary care, healthcare workers
MeSH terms: Community Health Workers, Community Health Services, Cost-Benefit Analysis, Delivery of Health Care, Developing Countries, Health Personnel, Humans, Primary Health Care, Work, Workload, Cost Savings

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Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries

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