Mixed-methods studyto validate and refine the &#39;Strategic Healthcare Implementation Framework for Task Shifting, Sharing and Resource Enhancement&#39; (SHIFT-SHARE) v1
Authors: Das Shukanto 
Published: July 2023

Background: In healthcare, task shifting and task sharing (TS/S) are mechanisms that rationally transfer services from providers with more skills or qualifications to workforces with shorter training or fewer qualifications.Global guidelines on task shifting by the World Health Organization recommended countries toexpand on TS/S via production of policy and implementation frameworks.However, implementation-specific frameworks for TS/S are lacking. The authors haveconceptualised a framework specific to TS/S, called the ‘Strategic Healthcare Implementation Framework for Task Shifting, Sharing and Resource Enhancement’ (SHIFT-SHARE).Its building blocks are based on popular change management theories, implementation models and program assessment tools.SHIFT-SHAREhas six stages laid down in a cycle, each offeringstepwise direction on how to operationalise TS/S. The following protocol will now be used to evaluate real-world validity, applicability and utility of SHIFT-SHARE. The protocol can be adopted and used by researchers attempting to evaluate similar aspects of other implementation frameworks or service delivery models. Objectives: The current protocol describes how data on stakeholder experiences with TS/Sin context of health services in India will be collected and how their viewpoints on SHIFT-SHARE will be analysed, to further incorporate their recommendations and fine-tune SHIFT-SHARE.Primary objectives of this planned study are (1) to examine whether services adhere to the overarching philosophy of SHIFT-SHARE and (2) to study how organisations incorporate each component of SHIFT-SHARE into implementation processes and assess quality markers at each stage.Secondary objectives are (1)to appraise enablers and barriers to TS/S in context of SHIFT-SHARE, with a focus on power dynamics, sociocultural norms and regulatory policies, (2)to understand whether front-line healthcare providers get opportunities to contribute to or provide feedback at different stages of TS/S and review these in context of SHIFT-SHARE, (3) toappreciate provider and recipient experiences with TS/S and place these in context of SHIFT-SHAREand (4)to investigate whether TS/S has been reversed after being implemented and learn why. Methodology:The study will be qualitative and mixed-methods. The setting for this planned study is India. Data is to be collected via semi-structured interviews, focus group discussions and non-participative participant observations.Participants will include organisation-based or privately-practicing frontline providers, public health and community health workers and volunteers, who have been part of services that incorporate TS/S, and directors, managers, administrators, trainers, supervisors, auditors or support staff of such services. Subject experts, academicians, policy makers and decision-makers on matters of health systems, health and social care will be enrolled. Patients who have received interventions from services that use TS/S to deliver care will also be included. Collected data will be coded and analysed usinga hybrid deductive-inductive approach. Results: Finings from this analysis are expected to provide insights on careaccess, care quality and safety of TS/S-based services as perceived by stakeholders. The study will reveal whether stakeholders endorse TS/S and are prepared to employ it as prescribed by SHIFT-SHARE, and will help identify enablers and barriers to its implementation. The analysis will offer user-feedback on SHIFT-SHARE, particularly on its relevance, readability, clarity and applicability. Deeper understanding of the framework’s merits and demits will be obtained. These information will be useful to strengthen the framework before disseminating it.