Advertisement

Current Cardiology Reports

, 17:115 | Cite as

Healthcare Professional Shortage and Task-Shifting to Prevent Cardiovascular Disease: Implications for Low- and Middle-Income Countries

  • Lungiswa Primrose Tsolekile
  • Shafika Abrahams-Gessel
  • Thandi PuoaneEmail author
Public Health Policy (TA Gaziano, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Public Health Policy

Abstract

Cardiovascular diseases (CVD) account for 18 million of annual global deaths with more than three quarters of these deaths occurring in low- and middle-income countries (LMIC). In LMIC, the distribution of risk factors is heterogeneous, with urban areas being the worst affected. Despite the availability of effective CVD interventions in developed countries, many poor countries still struggle to provide care due to lack of resources. In addition, many LMIC suffer from staff shortages which pose additional burden to the healthcare system. Regardless of these challenges, there are potentially effective strategies such as task-shifting which have been used for chronic conditions such as HIV to address the human resource crisis. We propose that through task-shifting, certain tasks related to prevention be shifted to non-physician health workers as well as non-nurse health workers such as community health workers. Such steps will allow better coverage of segments of the underserved population. We recognise that for task-shifting to be effective, issues such as clearly defined roles, evaluation, on-going training, and supervision must be addressed.

Keywords

Healthcare staff shortages Cardiovascular disease Task-shifting Nurses Community health workers Low- and middle-income countries 

Notes

Compliance with Ethical Standards

Conflict of Interest

L.P. Tsolekile, S. Abrahams-Gessel and T. Puoane declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Organization WH. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. 2013.Google Scholar
  2. 2.••
    Leeder S, Raymond S, Greenberg H, Liu H, Esson K. A race against time: the challenge of cardiovascular disease in developing economies. 2004. New York, Trustees of Columbia University Ref Type: Serial (Book, Monograph) 2012. This report highlights the need for collective action in order to deal with CVD in LMIC because of their health and economic impacts. It further highlights interventions and provides a forecast of the burden on CVD if no action is take Google Scholar
  3. 3.
    Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367:1747–57.CrossRefPubMedGoogle Scholar
  4. 4.
    Organization WH. Cardiovascular diseases (CVDs). Updated 2015.Google Scholar
  5. 5.
    Murray CJL, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2197–223.CrossRefPubMedGoogle Scholar
  6. 6.
    O'Flaherty M, Buchan I, Capewell S. Contributions of treatment and lifestyle to declining CVD mortality: why have CVD mortality rates declined so much since the 1960s? Heart. 2013;99:159–62.CrossRefPubMedGoogle Scholar
  7. 7.
    Stringhini S, Viswanathan B, Gédéon J, Paccaud F, Bovet P. The social transition of risk factors for cardiovascular disease in the African region: evidence from three cross-sectional surveys in the Seychelles. Int J Cardiol. 2013;168:1201–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Krishnamurthi RV, Feigin VL, Forouzanfar MH, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet Global Health. 2013;1:e259–e81.CrossRefPubMedGoogle Scholar
  9. 9.
    Alwan A. Global status report on noncommunicable diseases 2010: World Health Organization; 2011.Google Scholar
  10. 10.
    Yusuf S, Rangarajan S, Teo K, et al. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med. 2014;371:818–27.CrossRefPubMedGoogle Scholar
  11. 11.
    Yusuf S, Hawken S, Ôunpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study. Lancet. 2004;364:937–52.CrossRefPubMedGoogle Scholar
  12. 12.
    Gersh BJ, Sliwa K, Mayosi BM, Yusuf S. Novel therapeutic concepts: the epidemic of cardiovascular disease in the developing world: global implications. Eur Heart J. 2010;31:642–8.CrossRefPubMedGoogle Scholar
  13. 13.••
    Atun R, Jaffar S, Nishtar S, et al. Improving responsiveness of health systems to non-communicable diseases. Lancet. 2013;381:690–7. This paper highlights the importance of health services that profile risks for NCDs in their population as well as strategies to strenghten the health system by using existing programmes. It draws on examples to show how health systems have been strenghtened through HIV and thus suggests an need for intergrating NCD prevention and control with HIV and other programmes. CrossRefPubMedGoogle Scholar
  14. 14.
    Samb B, Desai N, Nishtar S, et al. Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries. Lancet. 2010;376:1785–97.CrossRefPubMedGoogle Scholar
  15. 15.
    Home P, Haddad J, Latif ZA, et al. Comparison of national/regional diabetes guidelines for the management of blood glucose control in non-western countries. Diabetes Ther. 2013;4:91–102.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Igbojiaku OJ, Harbor OC, Ross A. Compliance with diabetes guidelines at a regional hospital in KwaZulu-Natal, South Africa. Afr J Prim Health Care Fam Med. 2013;5:5.CrossRefGoogle Scholar
  17. 17.
    Organization WH. The global shortage of health workers and its impact. WHO online, April 2006.Google Scholar
  18. 18.
    Organization WH. Task shifting to tackle health worker shortages. Geneva: WHO; 2007.Google Scholar
  19. 19.
    Anyangwe SC, Mtonga C. Inequities in the global health workforce: the greatest impediment to health in sub-Saharan Africa. Int J Environ Res Public Health. 2007;4:93–100.PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Tawfik L, Kinoti SN. The impact of HIV/AIDS on the health workforce in developing countries. document de base préparé pour Le Rapport sur la santé dans le monde 2006:8.Google Scholar
  21. 21.
    Mullan F, Frehywot S, Omaswa F, et al. Medical schools in sub-Saharan Africa. Lancet. 2011;377:1113–21.CrossRefPubMedGoogle Scholar
  22. 22.•
    Peck R, Mghamba J, Vanobberghen F, et al. Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey. Lancet Global Health. 2014;2:e285–e92. This paper describes the flaws in the health system that need to be addressed in order to provide primary care for NCDs. In addition it draws on the HIV programmes’ experience and suggests that such programmes can be used as models and a platform for improving NCD care. CrossRefPubMedGoogle Scholar
  23. 23.
    Agyemang C, Attah-Adjepong G, Owusu-Dabo E, et al. Stroke in Ashanti region of Ghana. Ghana Med J. 2013;46:12–7.Google Scholar
  24. 24.
    De-Graft Aikins A, Pitchforth E, Allotey P, Ogedegbe G, Agyemang C. Culture, ethnicity and chronic conditions: reframing concepts and methods for research, interventions and policy in low- and middle-income countries. Ethn Health. 2012;17:551–61.CrossRefPubMedGoogle Scholar
  25. 25.
    W-a P, Steyn NP, Levitt NS, Lombard CJ. They think they know but do they? Misalignment of perceptions of lifestyle modification knowledge among health professionals. Public Health Nutr. 2011;14:1429–38.CrossRefGoogle Scholar
  26. 26.
    Joshi R, Jan S, Wu Y, MacMahon S. Global inequalities in access to cardiovascular health care: our greatest challenge. J Am Coll Cardiol. 2008;52:1817–25.CrossRefPubMedGoogle Scholar
  27. 27.
    Dambisya Y. Task shifting in Uganda: case study. Washington, DC: Futures Group, Health; 2010.Google Scholar
  28. 28.
    Shifting WT. Rational redistribution of tasks among health workforce teams: global recommendations and guidelines. Geneva: World Health Organization; 2008.Google Scholar
  29. 29.
    Lehmann U, Van Damme W, Barten F, Sanders D. Task shifting: the answer to the human resources crisis in Africa? Hum Resour Health. 2009;7:49.PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    McPake B, Mensah K. Task shifting in health care in resource-poor countries. Lancet. 2008;372:870–1.CrossRefPubMedGoogle Scholar
  31. 31.
    Organization WH. The world health report: 2006: working together for health. 2006.Google Scholar
  32. 32.
    Callaghan M, Ford N, Schneider H. A systematic review of task-shifting for HIV treatment and care in Africa. Hum Resour Health. 2010;8:8–16.PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Morris MB, Chapula BT, Chi BH, et al. Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia. BMC Health Serv Res. 2009;9:5.PubMedCentralCrossRefPubMedGoogle Scholar
  34. 34.
    Shumbusho F, van Griensven J, Lowrance D, et al. Task shifting for scale-up of HIV care: evaluation of nurse-centered antiretroviral treatment at rural health centers in Rwanda. PLoS Med. 2009;6:1139.CrossRefGoogle Scholar
  35. 35.
    Ford N, Chu K, Mills EJ. Safety of task-shifting for male medical circumcision: a systematic review and meta-analysis. AIDS. 2012;26:559–66.CrossRefPubMedGoogle Scholar
  36. 36.
    Abrahams-Gessel S, Denman CA, Montano CM, et al. Training and supervision of community health workers conducting population-based, noninvasive screening for CVD in LMIC. Global Heart. 2015;10:39–44.CrossRefPubMedGoogle Scholar
  37. 37.
    Bedelu M, Ford N, Hilderbrand K, Reuter H. Implementing antiretroviral therapy in rural communities: the Lusikisiki model of decentralized HIV/AIDS care. J Infect Dis. 2007;196:S464–S8.CrossRefPubMedGoogle Scholar
  38. 38.
    Tunstall-Pedoe H. Preventing chronic diseases. A vital investment: WHO global report. Geneva: World Health Organization, 2005. pp 200. CHF 30.00. ISBN 92 4 1563001. Also published on http://www.who.int/chp/chronic_disease_report/en. International Journal of Epidemiology 2006;35:1107-.
  39. 39.
    Puoane TR, Tsolekile L, Igumbor EU, Fourie JM. Experiences in developing and implementing health clubs to reduce hypertension risk among adults in a South African population in transition. International journal of hypertension 2012;2012.Google Scholar
  40. 40.
    Norris SL, Chowdhury FM, Van Le K, et al. Effectiveness of community health workers in the care of persons with diabetes. Diabet Med. 2006;23:544–56.CrossRefPubMedGoogle Scholar
  41. 41.
    Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457–502.PubMedCentralCrossRefPubMedGoogle Scholar
  42. 42.
    Joshi R, Santo K, Redfern J. Task shifting for cardiovascular disease management: what can be learned from other models? J Cardiol Ther. 2014;1:88–91.Google Scholar
  43. 43.
    Organization WH. NCD global monitoring framework: ensuring progress on non-communicable diseases in countries. Cited June 2014;4.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Lungiswa Primrose Tsolekile
    • 1
  • Shafika Abrahams-Gessel
    • 2
  • Thandi Puoane
    • 1
    Email author
  1. 1.University of the Western CapeBellvilleSouth Africa
  2. 2.Center for Health Decision ScienceHarvard School of Public HealthBostonUSA

Personalised recommendations