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 .
Background Task shifting has become an increasingly popular way to increase access to health services , especially in low-re source setting s. 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 .
Costs and cost-effectiveness of different DOT strategies for the treatment of tuberculosis in Pakistan. Directly Observed Treatment.
An economic study was conducted alongside a clinical trial at three sites in Pakistan to establish the costs and effectiveness of different strategies for implementing directly observed treatment ( DOT ) for tuberculosis . Patients were r and omly allocated to one of three arms : DOTS with direct observation by health workers ( at health centres or by community health workers ) ; DOTS with direct observation by family members ; and DOTS without direct observation . The clinical trial found no statistically significant difference in cure rate for the different arms . The economic study collected data on the full range of health service costs and patient costs of the different treatment arms . Data were also disaggregated by gender , rural and urban patients , by treatment site and by economic categories , to investigate the costs of the different strategies , their cost-effectiveness and the impact that they might have on patient compliance with treatment . The study found that direct observation by health centre-based health workers was the least cost-effective of the strategies tested ( US dollars 310 per case cured ) . This is an interesting result , as this is the model recommended by the World Health Organization and International Union against Tuberculosis and Lung Disease . Attending health centres daily during the first 2 months generated high patient costs ( direct and in terms of time lost ) , yet cure rates for this group fell below those of the non-observed group ( 58 % , compared with 62 % ) . One factor suggested by this study is that the high costs of attending may be deterring patients , and in particular , economically active patients who have most to lose from the time taken by direct observation . Without stronger evidence of benefits , it is hard to justify the costs to health services and patients that this type of direct observation imposes . The self-administered group came out as most cost-effective ( 164 dollars per case cured ) . The community health worker sub-group achieved the highest cure rates ( 67 % ) , with a cost per case only slightly higher than the self-administered group ( 172 dollars per case cured ) . This approach should be investigated further , along with other approaches to improving patient compliance
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 .
Background Task shifting has become an increasingly popular way to increase access to health services , especially in low-re source setting s. 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 .