Task sharing in psychotherapy as a viable global mental health approach in resource-poor countries and also in high-resource settings

A global disparity exists between the burden of mental ill-health and the resources available to address this issue.Common mental disorders,such as mild-to-moderate depression,anxiety disorders and post-traumatic stress disorder,are associated with a significant decline in health and functioning and contribute significantly to the overall burden of disease.In view of a shortage of mental health professionals in most low-and middle-income countries,task sharing(task shifting)can make an important contribution to improving access to mental health services.Task sharing involves non-specialists in the delivery of health care.The use of lay health workers is premised on the assumption that the shorter training required for non professionals will allow an increase in the provision of required care without the need for an increase in resources and will strengthen and scale-up sustainable health systems.The need for low-tech support in the management of conunon mental disorders is widespread,and the core resource is humans trained to identify and treat those requiring mental health care.There is a strong evidence base for the effectiveness of task sharing in psychotherapy,and talk therapies,e.g.cognitive behavioral therapy,can easily be delegated to non-specialists,including non-specialist health workers,peer helpers and lay people.A(cost-)effective model of mental health care in low-resource settings as well as in high-income countries may include the medical school-based training of some psychiatrists and clinical psychologists in the treatment of referred patients with serious mental illness.These professional mental health specialists would also be trainers and supervisors of non-specialist health workers who would identify common mental health disorders and provide psychotherapy to people with these conditions in a community-based setting.Community-based generalism including task sharing rather than centralized specialism may be capable of preventing and treating many common mental disorders with minor financial expenditure.

Effectiveness of Task Sharing and Task Shifting on the Uptake of Family Planning in Kenya

Background: Contraception is an inexpensive and cost-effective intervention, but health workforce shortages and restrictive policies on the roles of mid and lower-level cadres limit access to effective contraceptive methods in many settings. Task sharing and task shifting are strategies that can be adopted to increase uptake of health services including family planning. Methods: We collected data through online survey, key informant interviews and focused grouped discussions with an intervention group and that implemented the task sharing and task shifting policy guidelines and a control group that did not implement the policy. A total of 434 questionnaires were filled by health workers’ in primary health care facilities to assess effectiveness of task sharing and task shifting on the uptake of family planning services including its strengths and challenges. The questionnaire was designed with the aim of getting data on services provided by the cadres on effectiveness (number of clients, increase in use of methods, access to services), how they perceive these tasks, the bottlenecks and facilitating factors associated with the practice of task sharing and task shifting. Results: We found out that the task sharing and task shifting can expand and increase access to services as stated by 95% of the respondents. Most community health workers provided more of the family planning services at 45% with only 5% of the services of family planning being provided by medical officers. 98% of family planning services were integrated with other services. Task shifting was beneficial to the health care providers as well as the clients and the success of task sharing and task shifting depended on training, supportive supervision and a regulated environment through policies. Conclusion: The study shows that formalized task sharing and task shifting can increase health service uptake especially when community health workers are involved to provide services in the community. This leads to increased service provision, equivalent health professional performance across cadres and patient outcomes in the provision of family planning services.

Roles of the eye care workforce for task sharing in management of diabetic retinopathy in Cambodia

AIM： To identify the current roles of eye and health care workers in eye care delivery and investigate their potential roles in screening and detection for management of diabetic retinopathy（DR） through task sharing.METHODS： Purposive sampling of 24 participants including health administrators, members from non-government organizations and all available eye care workers in Takeo province were recruited. This cross sectional mixed method study comprised a survey and in-depth interviews. Data were collected from medical records at Caritas Takeo Eye Hospital（CTEH） and Kiri Vong District Referral Hospital Vision Centre, and a survey and interviews with participants were done to explore the potential roles for task sharing in DR management. Qualitative data were transcribed into a text program and then entered into N-Vivo（version 10） software for data management and analysis. RESULTS： From 2009 to 2012, a total of 105 178 patients were examined and 14 030 eye surgeries were performed in CTEH by three ophthalmologists supported by ophthalmic nurses in operating and eye examination for patients. Between January 2011 and September 2012, 151 patients（72 males） with retinal pathology including 125（83%） with DR visited CTEH. In addition 170 patients with diabetes were referred to CTEH for eye examinations from Mo Po Tsyo screening programs for people with diabetes. Factors favouring task sharing included high demand for eye care services and scarcity of ophthalmologists.CONCLUSION： Task sharing and team work for eye care services is functional. Participants favor the potential role of ophthalmic nurses in screening for DR through task sharing.

Task Co-Representation in Aging: An Event-Related Potential Study

The goal of the present study was to investigate age-related changes in attentional allocation for shared task representations during joint performance;event-related potentials were recorded while participants performed a modified visual three-stimulus oddball task, both alone and together with another participant. Younger adults and older adults (14 each) participated in the study. Participants were required to identify rare target stimuli while ignoring frequent standards, as well as rare non-targets assigned to a partner’s action (i.e., no-go stimuli for one’s own task). ERP component, nogo-P3 and P3b were measured to investigate the inhibition and the attentional allocation to the partner’s stimuli. Results showed that younger adults elicited larger frontal nogo P3 and parietal P3b for non-targets in the joint than in the individual condition. Contrary to expectation, older adults induced frontal no-go P3 in the joint condition not in the individual condition. In the sharing of the task with another, the result suggested that the efficiency of matching of incoming information with the representation of the other’s task declined with age, whereas aging did not affect the suppression of incorrect preparation of motor responses instigated by this representation.

The Austrian Botanic Gardens Work Group,an Example of Active Networking to Promote Small Botanic Gardens

The continuously increasing demands on botanic gardens during the last few decades have led to a huge in increase administration and an urgent need for additional specialized personnel,especially botanists,teachers,database specialists and administrative staff.Instead of meeting these requirements,many botanic gardens are faceing a severe decrease in funding and personnel.Larger gardens provide the opportunity to distribute several tasks to different employees,whereas small gardens are short staffed and often run by a single curator who has to fulfill all functions.In order to meet actual demands more easily,the Austrian botanic gardens are linked nationally via an active workgroup.This network not only allows the distribution of information but also facilitates the sharing of duties.A listserver speeds up the communication and correspondence within the workgroup,collection priorities and projects(e.g.,GSPC) are coordinated,seedbanking becomes decentralized,printed matters are shared and distributed,etc.Small gardens with only few employees can participate in projects by taking on small-ideally using with their special resources-in order not to fall behind.In addition,there is also an urgent need for international networking by means of plant and seed exchange(Index Seminum),BGCI membership,discussion groups,personal contacts and projects.Mission statements,special marketing strategies for public relations,integrating projects of other workgroup members and adapted public awareness programs are important to focus attention to small gardens and to help them keep alive.