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Invited Commentary
June 26, 2019

Task Shifting in Surgery—What US Health Care Can Learn From Ghana

Author Affiliations
  • 1Department of Surgery, Stanford University School of Medicine, Stanford, California
  • 2General Surgery, Palo Alto Veterans Healthcare System, Palo Alto, California
  • 3Surgeons OverSeas, New York, New York
JAMA Surg. Published online June 26, 2019. doi:10.1001/jamasurg.2019.1745

Task shifting is a process whereby specific duties are moved to health care workers with shorter training times and fewer qualifications. The process may also involve delegation of clearly delineated responsibilities to newly created cadres of health care workers after completion of specific competency-based training.1 In high-income countries, successful, sometimes controversial, examples of task shifting include donor lung procurements by physician assistants,2 midlevel clinicians performing diagnostic and therapeutic endoscopy,3 and hernia repairs performed by general practitioners.4 In resource-limited countries, multiple studies report safe outcomes for procedures performed by nonsurgeons, including those done even by nonphysicians.5 Depending on the country, a significant number of surgeries in low- and middle-income countries are performed by both nonsurgeons and nonphysicians, including 90% of obstetric surgeries, 38.5% of general surgery procedures, and 43% of nonobstetric laparotomies.6

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