The emergence and re-emergence of infectious diseases remain a major public health threat in Europe. The Horizon Europe-funded MOBILISE project addresses this challenge by establishing a One Health Mobile Laboratory capable of handling risk group 3 and 4 pathogens, while strengthening outbreak preparedness through targeted capacity-building activities and the development of a rapid-response expert network. A key component of the project is a training-of-trainers (ToT) model, which enables participants to perform critical tasks in the field and transfer expertise within their home countries. This approach expands the pool of skilled professionals and strengthens collective preparedness. A descriptive mixed-methods programme evaluation, including pre- and post-test assessments, was conducted to assess the ToT model's implementation. In the first phase, two laboratory experts from each partner country were selected. They completed online courses, followed by a two-week in-person training at the Bernhard Nocht Institute for Tropical Medicine in Hamburg, Germany. Training covered biosafety, molecular diagnostics, sequencing, and mobile laboratory operation. The programme concluded with four field missions, allowing participants to apply their skills and train new cohorts. The evaluation also highlighted challenges related to retaining trained experts within the expert pool over time. This structured approach enhances outbreak preparedness, fosters cross-border collaboration, and strengthens the resilience of the health system.
The role of pharmacists in providing clinical activities has been expanded in several countries to address the increasing demand for healthcare services. This paper aims to (1) quantitatively investigate the relationship between job satisfaction and involvement in clinical activities among hospital and community pharmacists in Australia; (2) and assess whether mismatches between actual and acceptable levels of extrinsic factors are associated with job satisfaction among pharmacists. Using data from a nationwide cross-sectional survey of 392 hospital and community pharmacists, we found a positive association between involvement in clinical activities and job satisfaction among community pharmacists (β = 0.99, p-value = 0.01). Consistent with Herzberg’s theory, we observed positive associations between job satisfaction and intrinsic factors (recognition of pharmacists’ work) and extrinsic factors (flexible work schedule and salary). Furthermore, we found that the existence of a mismatch between actual and acceptable levels of extrinsic factors was negatively associated with job satisfaction. Our findings suggest that expanding the role of community pharmacists to include more clinical tasks may align with their intrinsic motivation. Our paper highlights the importance of considering workers’ preferences and expectations to enhance their well-being. We recommend that healthcare organizations and policymakers consider the design of pharmacists’ roles to align with pharmacists’ values and needs, thereby improving pharmacists’ job satisfaction and the quality of care provided to patients.
Japan's physician workforce problem in hospital-based high-intensity care is better understood as an interaction between distribution and retention than as a simple question of national physician headcount. This Comment examines three pathways that can reduce hospital service capacity: working conditions that impede entry and career continuity in high-intensity specialties; early movement from initial residency into cosmetic medicine, known as choku-bi; and later movement from hospital employment to clinic practice. Recent national data show substantial improvement in physician working hours after the 2024 Work Style Reform, but long hours remain concentrated in surgery, emergency medicine, and obstetrics and gynaecology. The national prevalence of choku-bi is not known; professional-society data instead provide a limited indicator of early entry into cosmetic practice. Published income data also show a large difference between salaried hospital practice and clinic ownership, but do not establish that income causes physicians to leave hospitals. These distinctions matter because national supply, specialty distribution, and movement across care settings are analytically different problems. Policy should therefore focus on measurable retention and distribution mechanisms: phasing out routine dependence on the highest service-related overtime ceilings, testing targeted retention incentives for high-intensity hospital functions, strengthening training and competency governance in cosmetic medicine, supporting career continuity, and collecting longitudinal data on physician transitions. Japan illustrates a broader workforce principle: adequate national headcount does not guarantee adequate service capacity when clinicians are difficult to distribute and retain in the settings where they are needed.
Cross-border healthcare is increasing globally due to factors such as migration, population mobility and disparities in healthcare availability between neighbouring countries. Despite growing interest in cross-border healthcare, research remains limited, particularly regarding the experiences and perceptions of healthcare workers responsible for delivering care to cross-border patients. Understanding these experiences is essential for informing strategies to improve healthcare access and delivery for populations living in border regions. This study explored and described healthcare workers’ experiences and perceptions of providing healthcare to cross-border patients in a district of Namibia. A qualitative interpretive phenomenological design was employed. Purposive sampling was used to recruit ten healthcare workers with diverse professional backgrounds and experiences. Data were collected through face-to-face, semi-structured interviews and analysed using Colaizzi’s seven-step descriptive phenomenological method. Four themes emerged from the data: (1) language differences and communication in shaping healthcare experiences; (2) the impact of cross-border patients on workload and healthcare workers’ perceptions; (3) the quality of healthcare delivered to cross-border patients; and (4) the financial implications of providing healthcare to cross-border patients. While healthcare workers generally expressed positive attitudes towards caring for cross-border patients, they reported challenges related to language barriers, continuity of care, resource limitations, and the financial burden on the healthcare system. Healthcare workers support the provision of healthcare services to cross-border patients despite several operational challenges. Strengthening cross-border healthcare arrangements through formal agreements between neighbouring countries, enhancing healthcare workers’ preparedness, and ensuring adequate resource allocation may improve the quality, continuity, and sustainability of healthcare services for cross-border populations.
In Singapore, the Healthier SG (HSG) reform is broadening the healthcare system’s focus beyond clinical care to include preventive and promotive primary healthcare, which is expected to significantly increase the workload of family physicians (FPs). Traditional staffing models fail to capture actual workloads, creating a need for evidence-based planning tools. This study, the first of its kind in a Singaporean polyclinic, applies the World Health Organization’s (WHO) Workload Indicators of Staffing Need (WISN) methodology to determine optimal FP staffing levels needed under the new HSG model. A single-site, mixed-methods pilot study was conducted at a public primary care clinic in Singapore. The WHO’s WISN methodology was used to quantify physician staffing requirements based on 2024 workload data, incorporating health services, support and additional activities. Activity standards were determined through electronic health records, clinic statistics and expert consensus. The WISN software was used to calculate the total staff required and the WISN ratio. In-depth interviews with five FPs were conducted to contextualise and triangulate quantitative findings. WISN analysis found a staffing requirement of 28 full-time equivalent (FTE) FPs, compared to the current staffing of 22 FTEs, resulting in a WISN ratio of 0.79. This indicates that the FP workforce is overworked, operating at 79
The 2016 global strategy on health human resources highlights the health workforce as a cornerstone of sustainable and resilient health systems. Over the last decade, Guinea has launched great reforms to tackle critical health workforce challenges, including shortages and geographical imbalances. We undertook this study to understand the implications of these reforms on the availability, distribution, gender composition, and employment of the workforce in rural areas. We conducted a health labour market analysis focusing on HRH data in two regions—N’zérékoré and Kindia—using mixed-methods approach. Data were collected from private and public health facilities and training institutions, complemented by policy documents and literature published between 2018 and 2024. The analysis focused on key indicators of workforce production, availability, distribution, employment and gender equity. In 2024, the two study regions reported 9,545 skilled health workers across ten health professions, predominantly state-registered nurses (36.7
Effective management of communicable diseases (CDs) requires a professional, motivated, and dedicated health workforce. Afghanistan, which bears a high burden of CDs, faces significant challenges in maintaining such a workforce. This study aims to strategically analyze human resource management (HRM) for CDs in Afghanistan and to propose appropriate strategic solutions. A qualitative study was conducted between February 27 and September 21, 2024 using interpretative phenomenology (IP) through semi-structured interviews with 49 experts, including policymakers, managers, service providers, and NGO officers within Afghanistan’s health system. Data were analyzed using a framework analysis approach guided by a SWOT (Strengths, Weaknesses, Opportunities, and Threats) framework to identify factors related to the health workforce in CDs management, including challenges and potential solutions. The study identified 15 strengths, 16 weaknesses, 8 opportunities, 13 threats, and 23 potential solutions related to HR for managing CDs. Key strengths included an established network of community health workers and recruitment through online platforms. Major weaknesses involved inequitable distribution of health personnel, imbalance between supply and demand, shortage of qualified managers, insufficient female health workers, lack of CD specialists, and inadequate salaries. Opportunities included the presence of a young health workforce, while key threats were brain drain, resource limitations, and restrictions on women’s education. Proposed solutions emphasized improving retention strategies, increasing recruitment budgets, promoting female education, and raising salaries for health professionals. Effective management of CDs in Afghanistan requires a knowledgeable, sufficient, and well-supported workforce. Addressing workforce challenges through strategic planning, recruitment, and retention initiatives—guided by insights from the SWOT analysis—can strengthen the health system’s capacity for sustainable CD control.
Continuing professional development (CPD) plays a vital role in maintaining the competence of health professionals and ensuring quality health care. Health emergencies such as the coronavirus disease 2019 (COVID-19) pandemic and armed conflicts globally have disrupted traditional educational formats and accelerated the adoption of digital and online learning. This study explores the Armenian experience of CME transformation during recent crises, focusing on the transition to online education, its outcomes, challenges, and opportunities for long-term reform. A descriptive analysis of CME/CPD activities conducted in Armenia during and after the COVID-19 pandemic and the 44-day War in Nagorno-Karabakh in 2020 was performed. Data on the number of online courses and participants were collected, and findings were interpreted in the context of international developments in CME/CPD during health emergencies. Armenia experienced a significant increase in online CME offerings and participation during recent crises, aligning with global trends. The shift ensured continuity of professional education, expanded access to rural areas, and enhanced workforce preparedness. However, challenges emerged, including the absence of a comprehensive regulatory framework, limited quality assurance mechanisms, and concerns regarding sustainability and equity. Armenia’s experience reflects global patterns of emergency-driven innovation in CME but also highlights specific national challenges. Lessons from international practice demonstrate the need for stronger regulation, monitoring and integration of CME with workforce planning systems. The Armenian experience demonstrates how a health workforce development system adapted to substantial challenges through the rapid expansion of digitally enabled CME/CPD, regulatory flexibility, and international collaboration. While further research is needed to assess long-term educational and workforce outcomes, the findings suggest that adaptive educational infrastructures may represent an important component of health workforce resilience during periods of crisis and recovery.
Due to the ongoing socioeconomic and political crisis in Lebanon, healthcare personnel face numerous challenges that are driving them toward emigration. This cross-sectional study examines the factors that affect Lebanese medical students’, doctors’, and nurses’ retention in the country. Data were collected from August to December 2024 from Lebanese medical students, doctors, and nurses during a severe socioeconomic and political crisis. Exploratory factor analysis (EFA) was conducted on 819 participants via a structured 60-item online survey following a Likert-style scale to identify key retention determinants. Reliability analysis was performed via Cronbach’s alpha and McDonald’s omega, with a Kaiser–Meyer–Olkin (KMO) value of 0.964 and a statistically significant Bartlett’s test of sphericity (p < 0.05), confirming the data’s suitability for factor analysis. Twelve retention factors were identified and ranked by importance: compensation benefits (mean = 4.58, α = 0.821), work‒life balance (mean = 4.55, α = 0.796), workplace sanitation security (mean = 4.54, α = 0.813), disaster preparedness crisis management (mean = 4.51, α = 0.919), job satisfaction recognition (mean = 4.50, α = 0.911), political economic stability (mean = 4.49, α = 0.844), autonomy (mean = 4.47, α = 0.809), support from colleagues (mean = 4.44, α = 0.889), career development (mean = 4.38, α = 0.773), support from management (mean = 4.38, α = 0.894), mental health stress management (mean = 4.31, α = 0.862), and workplace comfort amenities (mean = 4.20, α = 0.830). This study highlights the multifaceted factors influencing healthcare professionals’ retention in Lebanon amid ongoing crises. These insights provide an opportunity for policymakers and healthcare leaders to focus on critical areas where targeted investments could strengthen the retention of doctors, nurses, and medical students in Lebanon and possibly in other countries experiencing similar crises.
The shortage of health personnel facing China, particularly in rural areas, has posed a great obstacle to the sustainable development of its health system. The Chinese government has, therefore, implemented the Rural-Oriented Tuition-Waived Medical Higher Education (ROTWMHE) program to address this issue, which recruits and trains medical students (oriented medical students) with contracts to serve in designated areas. This study attempts to identify the contract compliance intention of medical students in the ROTWMHE program and investigate the influencing factors and mechanisms. From May to June 2023, a total of 1130 oriented medical students engaged in the ROTWMHE program were selected from oriented medical student educational institutions in Hubei Province to conduct questionnaire surveys. The questionnaire, based on the Theory of Planned Behavior, consisted of four parts: demographics, attitudes, subjective norms, and perceived behavioral control. Descriptive analysis, chi-square test, and multivariate logistic regression analysis were employed to identify the factors influencing the contract compliance intention of oriented medical students. A total of 1114 (98.58
Receiving health systems cannot improve refugee clinician integration pathways if no actor is responsible for the denominator, milestones, or stage-specific delays. England is a useful worked example. Published UK initiatives show that already-resident refugee and asylum-seeking doctors can reach NHS employment, supervised placements and professional registration, but they use different denominators, endpoints and follow-up conventions. They demonstrate feasibility without yielding a pathway metric that system-level purchasers, funders or regulators can compare, fund or improve. A minimum time-to-practice (TTP) specification would separate two clocks. A population or pre-pathway clock would record earlier dates, such as arrival, asylum-claim lodgement, first contact or first documentation of professional background, to show upstream delay and attrition. The pathway TTP clock would begin at pathway registration, when a minimum dataset is complete, a named pathway owner can act, and the case enters the reporting denominator. Two auditable milestones would then be measured from registration: TTP-1, the verified start of the first qualifying paid supervised placement; and TTP-2, practice-enabling, profession-equivalent registration. Work-eligibility status, documentation completeness, years out of practice and route complexity should be recorded to interpret variation rather than to exclude people from the denominator. TTP is not a measure of competence, programme effectiveness or speed alone. Its purpose is workforce governance: to define the denominator, milestones, safeguards and funding conditions needed to compare and improve a poorly observed route back into practice, while remaining distinct from active overseas recruitment.
Cancer is a complex global health issue that continues to overburden healthcare systems worldwide. Estimates suggest that the burden of cancer will double in the next decade, further straining healthcare systems if effective interventions are not scaled up. One critical barrier to scaling up cancer interventions is the shortage of the cancer workforce, which is particularly severe in low- and middle-income countries (LMICs) in sub-Saharan Africa, many of which do not have a single oncologist. Task shifting offers a potential strategy to expand the cancer workforce. However, there is limited evidence on task shifting to advanced clinical professionals, such as pharmacists, who could help improve access to cancer control services. Pharmacists are integral members of the healthcare team and possess advanced clinical knowledge that can be leveraged to enhance cancer care. In many LMICs, pharmacists serve as the first point of contact for health complaints and minor ailments, positioning them to aid in early diagnosis and intervention for cancer. The objective of this study is to develop a conceptual framework, TASK PACT (Task Shifting Concepts for Pharmacists to Advance Cancer Control and Treatment), to systematically assess the feasibility of task shifting selected cancer control services to pharmacists. The framework was developed through an integrative review of the literature on task shifting, and is grounded in a synthesis of intellectual capital, organizational readiness for change, motivation, and change theories, and the theoretical domains framework. It provides a structured approach to explore the perspectives of pharmacists, oncologists, policymakers, and patients regarding the acceptability, readiness, and practical implementation of expanding pharmacists’ roles in cancer control. The TASK PACT framework could serve as a practical tool for research that informs policy, guides implementation research, and supports the design of scalable, context-specific collaborative models of cancer care in sub-Saharan Africa. Its application could strengthen the oncology workforce, improve access to cancer control services, and generate evidence to inform broader health system strategies in LMICs.
Family doctor contract services (FDCS) are a key strategy to strengthen primary healthcare systems in China. Understanding preferences for the design of family doctor teams is essential for optimising health workforce performance and service delivery. This study aimed to elicit and compare the preferences of community residents and primary healthcare providers (PHPs) regarding key attributes of FDCS. Two discrete choice experiments (DCEs) were conducted, one for community residents and the other for PHPs. Attributes and levels were established using qualitative methods. There were six attributes for community residents and PHPs, with most attributes differing between the two groups, except for FDCS composition. Data were analysed using mixed logit models. A total of 1,110 community residents and 1,298 PHPs completed a discrete choice experiment questionnaire, resulting in effective response rate of 77.08
Human resources are fundamental to improving both service quality and patient outcomes. Given the critical role of accurate data on workforce distribution as a key hospital resource in planning and policymaking, this study aims to assess inequalities in the distribution of hospital human resources and their association with hospital mortality rates across the provinces of Iran. This cross-sectional quantitative study covered 31 provinces across Iran, analyzing data from 383 districts, which represent a comprehensive national-level examination of human resource distribution in the healthcare sector. The Gini coefficient was calculated at both national and sub-national levels. Additionally, stratified analyses were conducted by region to determine whether inequalities were more pronounced in specific geographic areas. The analysis of hospital human resources revealed mean physician and nurse densities of 0.34 and 1.28 per bed, respectively, with relative ratios (RR) of 0.67 and 0.80. The Gini coefficients indicated moderate inequality for physicians (0.19) and low inequality for nurses (0.10), while other staff showed intermediate values (mean 0.44, Gini 0.15). Variability across provinces was reflected in standard deviations, with the highest inequality observed in physician distribution (max Gini 0.59). These findings highlight uneven distribution patterns of hospital workforce components. The Gini coefficients indicate notable disparities, particularly among physicians, where some provinces experience far worse staffing levels compared to others. Targeted interventions, including incentivizing healthcare professionals to work in underserved areas and improving resource allocation models, are essential to enhance the fairness and efficiency of Iran’s healthcare system.
The Field Epidemiology Training Program (FETP) is a three-tier (Frontline, Intermediate, and Advanced) practical training that strengthens the capacity of the global public health workforce to detect and respond to epidemics. The U.S. Centers for Disease Control and Prevention (CDC) has supported the development of FETPs worldwide for over 40 years. A global cross-sectional evaluation was conducted with graduates from CDC-supported FETP Intermediate and Advanced programs to understand the application of FETP in their current job and its impact on their career progression. An online survey with Intermediate and Advanced FETP graduates was conducted from March to May 2022. Purposive and snowball sampling was used to recruit survey participants. Each participant received the survey link via email. The survey included questions on demographics, FETP competencies and functional areas, and the impact of training on career. Poststratification weights were applied based on the known proportions of the study population, and univariate and bivariate frequency distributions were calculated. Bivariate cross-tabulations for association were tested using the Rao–Schott Chi-square test of independence. The sample included 1493 graduates representing CDC-supported FETP programs from 49 countries. Three-quarters graduated from the advanced program (wt. n = 1108); 82
Background Professional support is an important strategy to improve the retention of rural doctors. However, it is poorly defined and understood within the context of rural medicine making it challenging to design and implement. This research aimed to explore what professional support entails and how it works and in what context, to improve whole of rural medical workforce retention. Methods An online expression of interest was circulated to 143 organisations/key informants potentially involved in professional support activities to which 87 replied. Thirty-three of the longest running and comprehensive professional support activities spread across different medical specialties and career stages, locations and target cohorts were selected. Respondents participated in up to two 1-h semi-structured interviews. Realist evaluation involved drawing out patterns about how professional support worked in what context to drive retention of rural doctors, to develop theory. The theory was developed, refined and confirmed with insights from an internal reference and external project advisory group. Results A whole of medical workforce conceptualisation of professional support was defined identifying that in the context of rural medicine, three categories of professional support could drive longer term retention of rural doctors in rural work. These were lifelong career support, sustainable practise support and healthcare and social support. Together, these categories are likely to co-stimulate generative mechanisms (rural doctors' sense of comfort, confidence, competence, belonging and bonding) to promote shorter term outcomes of feeling valued and connected on the path to longer term retention. Professional support interventions could be scaled up or down over time and should be responsive to the breadth and complexity of work of rural doctors, their level of isolation/autonomy and their socio-cultural stresses. Conclusions The findings articulate the concept of professional support across the rural medical workforce. The results suggest that professional support could be bundled and scaled up or down to address the holistic needs of individual doctors to generate better retention. The theory clarifies a range of professional support activity which could be coordinated through health services, education providers, government and wider agencies to more systematically ensure rural medicine is sustainable.
Background The surge in armed conflicts since the mid-2000s has significantly disrupted healthcare systems, leading to humanitarian crises and profound economic and infrastructure damage. This study explores the experiences of healthcare professionals to examine the impact of the war in Tigray on the healthcare system, professionals' livelihoods, community health, and healthcare services. Methods A qualitative study using a phenomenological approach was conducted in Tigray Regional State, Ethiopia, involving in-depth interviews with health professionals. Participants were selected through purposive sampling, focusing on those with clinical and administrative roles during the war. Data collection occurred between February and March 2022, with interviews conducted in Tigrigna. Results The war has devastated Tigray's healthcare infrastructure, leading to a collapse of health services and a significant decrease in healthcare professionals' quality of life. The community's health has deteriorated due to reduced healthcare access and increased disease prevalence. Key themes identified include the perils of war on a thriving health system, a community hanging by a thread, and resilience and hopes for recovery. The study highlights the urgent need for focused interventions to mitigate the conflict's impacts and foster long-term recovery in the region. Conclusions The Tigray war had a profound impact on the healthcare system, professionals, and community health. The findings underscore the necessity of urgent, coordinated efforts to rebuild the health sector, support affected professionals, and enhance community health resilience. This study provides crucial insights into the challenges faced by healthcare systems in conflict zones and the importance of safeguarding these systems against the ravages of war.
Abstract Background Currently, the health care system in Germany is facing a serious physician shortage. Previous research reported changes in working hours and a tendency towards a reduction in clinical hours. The aim was to investigate the relationship between changes in working hours and symptoms of burnout in German physicians over two time points. Method In 2020, a random sample of physicians from the Federal State of Saxony (Germany) was drawn. The current analyses are based on data from a longitudinal survey conducted in 2020 and 2024. Overall, a sample of n = 333 physicians working in both inpatient and outpatient care was investigated using descriptive and regression analyses. In a multivariate analysis predicting burnout symptoms (overall, patient-related, work-related, personal burnout) in 2024, sociodemographic factors such as age, sex and work-related aspects (i.e. medical setting and working hour characteristics), as well as burnout level in 2020, were controlled for. Results Overall, 19.2% (n = 64) of the sample reported no changes in working hours over 4 years, whereas 27% (n = 90) reported an increase in working hours and 53.8% (n = 179) reported a decrease in working hours. In fact, a working hour reduction was significantly linked to lower overall burnout, lower personal burnout and lower work-related burnout at follow-up (p < 0.001 for all regression models), while controlling for covariates. No significant association between change in working hours and the third burnout dimension—patient-related burnout at follow-up—was found. Discussion The present findings emphasize that physician burnout remains a critical issue, especially in the context of clinical working hours. Reducing actual working hours and decreasing overwork may help to improve physician well-being. Future efforts should also focus on optimizing working conditions beyond hours alone—such as increasing schedule flexibility and addressing systemic stressors—to sustainably protect physicians’ health and ensure high-quality patient care.
BACKGROUND:The Covid-19 pandemic highlighted the need for public health professionals to be embedded in country health systems. The Master of Public Health (MPH), offered widely, is accepted as the entry degree for public health practice in low- and middle-Income countries (LMICs). The aim of the study was to address the knowledge gaps on the career trajectories of MPH graduates from South African universities. METHODS:A research team from the eight South African universities that graduated MPH students between 2012 and 2016 obtained lists of alumni and invited them to participate in an on-line survey. The self-administered questionnaire elicited the demographic characteristics of MPH graduates, their educational and work background, the impact of the MPH on their subsequent work and their perspectives on the roles of MPH graduates. RESULTS:The overall 37% response rate varied by institution. Respondents were mid-career professionals, in their mid-30s with on average, nine years work life. A sizeable proportion came from sub-Saharan Africa and they returned to their home or a neighbouring country to work. Most had been managers or patient-facing health professionals, and the MPH was the route to shift into public health roles. After MPH completion, 91% were employed in government (40%), non-governmental organisations (32%) or academic/research institutions (21%) in technical, managerial or academic roles. The MPH was a stepping stone for career advancement, and 55% of study participants changed their employers post qualification. They envisaged that MPH graduates could assume leadership positions and effectively contribute across both technical and managerial domains, including during public health emergencies. CONCLUSION:The MPH degree was pivotal to graduates taking on public health roles in their home countries. In view of public health workforce shortages, the study findings contribute to planning for a competent cadre to tackle pressing public health problems and their social determinants and support robust health systems development in Africa.
Task shifting and task sharing (TS/S) redistribute responsibilities across cadres to expand access to healthcare, particularly in underserved areas. TS/S addresses workforce shortages and improves the availability of essential surgical procedures. The scope and geographical distribution of surgical TS/S programs are well documented, less is known about how TS/S initiatives are monitored and evaluated, especially with respect to trainee, program, and health systems outcomes. This review describes existing approaches to evaluation within surgical TS/S initiatives. We searched nine electronic databases (MEDLINE [Ovid], Embase [Ovid], CINAHL [EBSCO], Scopus, CABI Digital Library, Clarivate Web of Science, Evidence Aid, Global Index Medicus, and Eldis) on 31 January 2024 and 12 March 2025, using MeSH terms and keywords related to “Task Sharing” AND “Surgery”. All patient populations, practice settings, surgical skills, and study designs were eligible. No language or time restrictions were utilized. Publications that did not describe the evaluation of surgical skills, or that focused on skills within a practitioner’s typical scope of practice, were excluded. Two reviewers independently screened and extracted data. Risk of bias was assessed with MINORS. Findings were synthesized using inductive content analysis. Results were tabulated and presented graphically. Of 2483 identified records, 1609 unique publications were screened, 452 underwent full-text review, and 228 were included in the review. Most studies reported surgical TS/S in low-income countries (41.7
