Abstract:
Background: Demographic and epidemiological changes have prompted thinking on the need to broaden the
child health agenda to include care for complex and chronic conditions in the 0–19 years (paediatric) age range.
Providing such services will be undermined by general and skilled paediatric workforce shortages especially in lowand
middle-income countries (LMICs). In this paper, we aim to understand existing, sanctioned forms of task-sharing
to support the delivery of care for more complex and chronic paediatric and child health conditions in LMICs and
emerging opportunities for task-sharing. We specifically focus on conditions other than acute infectious diseases and
malnutrition that are historically shifted.
Methods: We (1) reviewed the Global Burden of Diseases study to understand which conditions may need to be
prioritized; (2) investigated training opportunities and national policies related to task-sharing (current practice) in
five purposefully selected African countries (Kenya, Uganda, Tanzania, Malawi and South Africa); and (3) summarized
reported experience of task-sharing and paediatric and child health service delivery through a scoping review of
research literature in LMICs published between 1990 and 2019 using MEDLINE, Embase, Global Health, PsycINFO,
CINAHL and the Cochrane Library.
Results: We found that while some training opportunities nominally support emerging roles for non-physician
clinicians and nurses, formal scopes of practices often remain rather restricted and neither training nor policy seems
well aligned with probable needs from high-burden complex and chronic conditions. From 83 studies in 24 LMICs,
and aside from the historically shifted conditions, we found some evidence examining task-sharing for a small set of
specific conditions (circumcision, some complex surgery, rheumatic heart diseases, epilepsy, mental health).
Conclusion: As child health strategies are further redesigned to address the previously unmet needs careful strategic
thinking on the development of an appropriate paediatric workforce is needed. To achieve coverage at scale
countries may need to transform their paediatric workforce including possible new roles for non-physician cadres to
support safe, accessible and high-quality care.
