Assessing Health Systems-level Feasibility of Task-Sharing and -Shifting: Cross-sectional Study from Indian District Hospitals

Abstract Introduction Low- and lower-middle-income countries face chronic deficits in specialist surgeons, particularly in rural and remote settings. Task-sharing and -shifting (TSS) to other health worker cadres is a remedy supported by effectiveness studies. However, policy adoption depends not only on effectiveness but also on feasibility at the health systems level, especially when personnel deficits co-occur across multiple cadres. We aimed to develop and apply an analytic approach to assess whether co-occurring workforce deficits constrain the feasibility of surgical TSS using a pan-Indian sample of district hospitals. Methods We conducted a cross-sectional descriptive analysis using administrative staffing data from the National Institution for Transforming India (NITI) Aayog assessment of 707 district hospitals for the 2017–18 financial year. Cadre-wise staffing ratios for specialist surgeons, general doctors, nurses, and paramedics were calculated using Indian Public Health Standards (IPHS) norms. A ratio