Task-Shifting and the Recruitment and Retention of Eye Health Workers in Under-Served Areas: A Literature Review

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.