LAUSR

Task Shifting in Dermatology—A Call to Action To the Editor In response to the Evidence Synopsis by Brown et al1 on the practice of task shifting, we would like to highlight how task shifting is currently being successfully implemented in health programs in India, with emphasis on National Leprosy Eradication Program. Task shifting refers to the strengthening of the peripheral health care workforce to provide better health care in the remote geographical areas. India is a large country with a vast population, and most of its people reside in remote rural areas; these people benefit greatly from task shifting.2 Health care workers are voluntary laypeople trained to promote health among their peers. They include accredited social health activists, village health guides, multipurpose health care workers, and many others. They serve a predefined population and are provided performance-based monetary incentives for their services.2 They carry out active surveillance of diseases and provide basic treatment, follow-up, and referral to medical officers, whenever needed. Periodic training helps them to meticulously plan and execute their activities, making it possible to decentralize otherwise centrally sponsored programs for tuberculosis, leprosy, vector-borne diseases, nutritional deficiencies, immunization, sexually transmitted infections, and reproductive, maternal, and child health. Dermatology is a visual specialty and can implement task shifting by training emissaries to diagnose few major skin ailments. The practice has been effectively used in the Indian National Leprosy Eradication Program, where grassroots multipurpose health care workers are trained to identify the hypopigmented patches, skin nodules, and deformities that are so characteristic of leprosy. They are also trained to make slit-skin smears whenever possible. Periodic intensified drives carried out in hyperendemic blocks have increased the new case detection rate by as much as 6 times.3,4 Within 6 days of active case surveillance carried out by trained multipurpose health care workers, 358 hidden cases of leprosy were identified increasing the annual new case detection rate from 21.3 to 28.9 per 100 000 persons and prevalence from 1.37 to 2.09 per 10 000 persons in a targeted block awareness campaign.5 Physical, cultural, and psychosocial proximity of the multipurpose health care workers to the community inspires trust and credibility in the population, resulting in enhanced participation in information, education, and communication activities. This in turn helps in earlier case detection and reduces the rates of disabilities and associated stigma in leprosy. To conclude, task shifting can help provide an earlier diagnosis and timely referral for those living in remote areas, but its implementation requires well-equipped training centers and meticulous strategies. It remains to be seen whether possible task shifting can be used to manage melanoma and basal cell carcinomas, the major dermatological health problems in Western populations.