Task-Shifting and the Recruitment and Retention of Eye Health Workers in
Under-Served Areas: A Literature Review
Abstract
Introduction The global burden of blindness is unequally
distributed and affects rural areas to a greater extent. The World
Health Organisation has specified task-shifting and increasing human
resources for eye health as two strategies to improve access to eye care
in under-served areas. It is unknown whether factors contributing to the
successful task-shifting of mid-level eye care providers, and factors
that lead to their successful recruitment and/or retention in
under-served areas are similar or complementary. Methods A
literature review was undertaken focussing on Ghana and Scotland: two
countries that have implemented task-shifting in eye care.
Results Four main areas were highlighted that must be addressed
for task-shifting and recruitment/retention of eye care workers to be
successful: training, incentivising to work in the right areas,
motivation to stay, and the means of productivity. Discussion
Incentives are effective in both task-shifting and recruitment/retention
but both financial and non-financial incentives should be carefully
considered, including at the student stage. Incentives should be given
for trainers as well as trainees. Task-shifted clinicians are motivated
to remain through clear career progression, learning opportunities, good
relationships with colleagues and management, and suitable remuneration
for the increased responsibility. The ability to meet the actual need of
the population is important and requires the legal ability to prescribe
medication. Adequate resources like equipment and consumables are
required to maintain motivation. Conclusion Factors leading to
successful task-shifting and recruitment/retention of eye care workers
in under-served areas are similar. Designing strategies to improve these
should evaluate context-specific motivational factors.