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 .
Coverage, Adherence and Costs of Intermittent Preventive Treatment of Malaria in Children Employing Different Delivery Strategies in Jasikan, Ghana
Background Intermittent preventive treatment of malaria in children ( IPTc ) involves the administration of a course of anti-malarial drugs at specified time intervals to children at risk of malaria regardless of whether or not they are known to be infected .  IPTc provides a high level of protection against uncomplicated and severe malaria , with monthly sulphadoxine-pyrimethamine plus amodiaquine ( SP&AQ ) and sulphadoxine-pyrimethamine plus piperaquine being the most efficacious regimens . A key challenge is the identification of a cost-effective delivery strategy . Methods A community r and omized trial was undertaken in Jasikan district , Ghana to assess IPTc effectiveness and costs using SP&AQ delivered in three different ways . Twelve villages were r and omly selected to receive IPTc from village health workers ( VHWs ) or facility-based nurses working at health centres ' outpatient departments ( OPD ) or EPI outreach clinics . Children aged 3 to 59 months-old received one IPT course ( three doses ) in May , June , September and October . Effectiveness was measured in terms of children covered and adherent to a course and delivery costs were calculated in financial and economic terms using an ingredient approach from the provider perspective . Results The economic cost per child receiving at least the first dose of all 4 courses was US$ 4.58 when IPTc was delivered by VHWs , US$ 4.93 by OPD nurses and US$ 5.65 by EPI nurses . The unit economic cost of receiving all 3 doses of all 4 courses was US$ 7.56 and US$ 8.51 when IPTc was delivered by VHWs or facility-based nurses respectively . The main cost driver for the VHW delivery was supervision , reflecting re sources used for travelling to more remote communities rather than more intense supervision , and for OPD and EPI delivery , it was the opportunity cost of the time spent by nurses in dispensing IPTc . Conclusions VHWs achieve higher IPTc coverage and adherence at lower costs than facility-based nurses in Jasikan district , Ghana . Trial Registration Clinical Trials.gov NCT00119132
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 .