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In the second context, extended and up-graded complaints are marked by the callers' refusals to accept complainable decisions and repeated rejections of call-takers' shift initiatives.
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A further significant policy shift initiative which may lead to an improvement in the recognition of delirium is the implementation of the dementia CQUIN (Commissioning for Quality and Innovation) target.
However, the role of traditional birth attendants (TBAs) within task shifting initiatives remains contested.
Where task shifting initiatives was introduced formally, there had been capacity building through training.
For scale-up of the task shifting initiatives, it will be helpful to document, disseminate and publicise such successes.
The issue of recruitment and deployment of unemployed health professionals was cited as a barrier to scaling up task shifting initiatives.
In broader context, such task shifting initiatives will remain limited, unless more significant progress is made with redefining the scopes of the professions and scopes of practices to allow for the optimum use of human resources.
The PALM PLUS approach is a potential model for supporting mid-level health care workers to provide front-line integrated primary care in low and middle income countries, and may be useful for future task-shifting initiatives.
An earlier task-shifting initiative in Zambia, which also found that HV lay counselors outperformed health care workers, sheds further light on our findings [ 34].
In 2006, clinic staff were asked to identify areas of patient care where they felt a task shifting initiative might be helpful due to the rapidly increasing workload.
PALSA PLUS then evolved into a more discretely task-shifting initiative, Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH); this focused on expanding primary-care nurses' roles to include prescribing antiretroviral treatment [ 13].
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