Table 1
Relevant literature reviewed for discussion.
| S/N | AUTHOR | OBJECTIVE OF STUDY | EFFECTIVENESS | CHALLENGES |
|---|---|---|---|---|
| 1 | Farley et al. [30] | Cross-sectional study on effectiveness of TSTS on management of MDRTB in South Africa | This study found that the success rate achieved in the clinical nurse practitioner lead treatment of MDRTB using TSTS was significantly higher than the national average in South Africa. Nurse-led treatment did not compromise patients’ outcomes. | |
| 2 | Dawson et al. [31] | Review of studies on TSTS in maternal and reproductive health in low-income countries | TSTS improved availability and access to quality maternal and reproductive health services. Cost effectiveness | In-service training Poor staff coordination and training Lack of equipment and drugs Supervision Career progression Incentives |
| 3 | Callaghan et al. [32] | Systematic review of task shifting on HIV care in sub-Saharan Africa | Improve access to HAARTs especially in the underserved areas Cost effectiveness Improve overall quality of care | Proper definition of roles and responsibilities to be shifted Inter-professional rivalry |
| 4 | Atand et al. [33] | Systematic review and meta-analysis on effectiveness of TSTS on blood pressure control among adults in low- and middle-income countries | TSTS was effective in blood pressure control, especially when health workers who are more educated such as nurses and pharmacists were involved | Inadequate supply of medications and equipment required for hypertension management |
| 5 | Ogungbe et al. [34] | Systematic review and meta-analysis on effectiveness of hypertension management using TSTS in low-income countries | Team-based hypertension management was effective in blood pressure control. Its effectiveness was dependent on the level of training of the non-physicians | |
| 6 | Some et al. [37] | Cross-sectional study on adherence of nurses to protocol for managing non-communicable disease during TSTS program in Kenya | Nurses have the capacity to effectively participate in TSTS by following treatment protocol and guidelines. | |
| 7 | Fisher et al. [38] | Prospective cohort study on the effectiveness of a remote non-physician hypertension management program | Remote BP management without involvement of physicians was found to be feasible | Physicians’ perception of losing autonomy or client base |
| 8 | Mailosi et al. [39] | Cross-sectional study on effectiveness of heart failure management by trained non-physician providers in Malawi | Trained non-physician health workers successfully treated patients with heart failure. They also had a higher rate of retention of patients. | Slightly higher mortality amongst patients managed for heart failure |
| 9 | Opkechi et al. [40] | Review of studies on task-shifting roles, intervention and outcomes for kidney and cardiovascular health service delivery among Africans | TSTS is effective in the diagnosis, creation of awareness and management of hypertension, diabetes mellitus, and kidney diseases. | Effectiveness of non-physicians health workers such as nurses, pharmacists, community health workers in their TSTS role is limited by their level of training and expertise |
| 10 | Kegne et al. [41] | Cross-sectional study on effectiveness of nurse-led hypertension management in Cameroon | Nurse-led hypertension clinics were effective in management of hypertension in both rural and urban communities. | Blood pressure control was more difficult to achieve in patients with hypertension who have additional co-morbidities such as diabetes mellitus. |
| 11 | Lulebo et al. [42] | Cross-sectional study on effectiveness of task shifting in hypertension management in Congo | Management of hypertension can be effectively achieved in primary health centres | There is absence of guideline on global assessment of cardiovascular risk assessment at primary level of care |
| 12 | Ogedegbe et al. [44] | Randomized control trial that compared the effectiveness of blood pressure control in those on health insurance coverage alone compared to those on health insurance coverage and nurse-led TSTS in Ghana | The combination of TSTS and provision of health insurance coverage achieved better blood pressure control in patients with hypertension compared with those on health insurance coverage alone. | There was no enabling health policy to support antihypertensive prescription by non-physician health workers such as nurses in Ghana. |
| 13 | Miao et al. [45] | Randomized control trial that assessed the effectiveness of nurse-led hypertension management model in health care in a Chinese urban community | Nurse-led hypertension management led to significant improvement in blood pressure control in those with uncontrolled hypertension. In addition, TSTS was led to better clients’ satisfaction with health services and improvement in their self-care behavior | |
| 14 | Goudge et al. [46] | Randomized control trial that assessed the effect of lay health workers in supporting provision of integrated chronic care in rural in primary health care clinics in South Africa | TSTS with lay health workers did not improve blood pressure control of those with hypertension; however, there was improvement in organization of clinic and clinic attendance. | Inadequate supply of medications and functioning sphygmomanometer Lack of spacious consulting room and large patient population relative to available health workers |
| 15 | He et al. [47] | Randomized control trial that assessed the effect of community health worker–led multicomponent intervention on blood pressure control among low-income patients with hypertension in Argentina | Community health worker-led home-based multi-component intervention significantly improved blood pressure control in those with uncontrolled hypertension. | |
| 16 | Duffy et al. [48] | Review of studies on different models of non-communicable disease (NCD) and HIV integration in low-income countries | Integration of NCD and HIV services could improve quality of NCD care and treatment outcomes. | Identified challenges were NCD supply chain, human resource for health, referral systems, patient education, stigmatization, and patient records, monitoring, and evaluation. |
| 17 | Mijovic et al. [51] | Systematic review of studies on TSTS experiences of health care workers in sub-Saharan Africa | TSTS was associated with better communication among health team and rational distribution of work. | For low cadre health workers: Inadequate compensation, lack of clear career path, high work burden, compromising patients’ safety and working beyond the scope of practice For high cadre health workers: Perception of diminution of their roles and influence in health sector |
| 18 | Gyamfi et al. [52] | Cross-sectional study that assessed the effect of training of nurses on their knowledge and practice hypertension management during task shifting in Ghana | Training of nurses in various aspects of hypertension management led to improvement in their knowledge, interpersonal skills, and patient education skills. | |
| 19 | Labhardt et al. [53] | Cross-sectional study that assessed the effectiveness of task shifting to non-physicians in hypertension and diabetes mellitus management in rural health facilities in Cameroon | Training of nurses in the management of hypertension and diabetes mellitus before commencement of TSTS led to improvement in capacity and knowledge to manage these conditions. Patients with diabetes mellitus and hypertension managed by nurses had significant improvement in their blood glucose and blood pressure control. | Low case-detection rate of hypertension and diabetes mellitus High attrition rate among enrollees with hypertension and or diabetes mellitus |
| 20 | Aifah et al. [54] | Cross-sectional study that assessed the perception of nurses to incorporation of hypertension management into HIV program in Nigeria using TSTS strategies | Nurses opined that incorporation of hypertension care in the existing HIV program through TSTS was highly feasible and has potential of reducing the burden of non-communicable diseases. | Limited hypertension knowledge among nurses who have not been specially trained Inadequate non-physician health workers to participate in TSTS Supportive supervision |
| 21 | Iwelunmor et al. [55] | Cross-sectional study that assessed the perception of stakeholders to hypertension management in Nigeria using TSTS strategies | TSTS led to reduction in workload of higher cadre health workers and improved patients’ awareness of their health condition. | Inadequate training and supportive supervision Lack of supportive leadership and inadequate facilities to manage hypertension The need for regular retraining due to high turnover of already trained staff Lack of awareness of treatment protocol and referral guidelines on hypertension |
| 22 | Baine et al. [56] | Cross-sectional study that assessed the perception of policy and decision makers on TSTS in hypertension management in Uganda | Lack of national policy and guidelines on TSTS Inadequate competency of low cadre health workers Lack of support by policy and decision makers Inadequate supportive supervision Non-involvement of health professional regulatory bodies Lack of adequate training, remuneration, and recognition of less skilled health workers involved in TSTS | |
| 23 | Joshi et al. [57] | Systematic review of studies on TSTS for management of NCD in low- and middle-income countries | TSTS improved health outcomes such as blood pressure control and medication adherence when compared with conventional health care. TSTS was found to be cost-effective. | Restriction of prescription of medications Inadequate supply of medicines |
| 24 | Kinuthia et al. [58] | Review of TSTS policies and guidelines in Kenya | TSTS improved health outcomes such as blood pressure control and medication adherence. It was also found to be cost effective. | Irregular supply of blood pressure medications and restriction of medication prescription Problem of retention of trained staff Absence of treatment guidelines Inadequate facilities such as glucose meters and sphygmomanometer |
| 25 | Munga et al. [60] | Cross-sectional study on TSTS experience in Tanzania | TSTS has the potential of improving access to health care in remote areas and increasing the retention of health workers in these areas as well. | Compromise of quality of care given to the patients Absence of monitoring and evaluation of the TSTS process Lack of supportive supervision |
| 26 | Ferrinho et al. [61] | Cross-sectional study that assessed experiences and opinions of health workers about TSTS in Zambia and Mozambique | Lack of career progression and recognition Lack of remuneration Increase workload for low and middle cadre health workers. Inadequate staffing and lack of facilities Lack of formal policy on TSTS |