Exploring Task-Shifting Approaches in Addressing Specialist Shortages to Enhance Access to Healthcare Services in Rural Kenya: A Systematic Review

Access to healthcare services in rural Kenya remains significantly constrained due to a chronic shortage of medical specialists, uneven distribution of resources, and weak health system structures. Task-shifting, the delegation of specific clinical responsibilities to non-specialist health workers, has emerged as a promising strategy to address these gaps. This systematic review aimed to evaluate how task-shifting influences access to healthcare services in rural Kenya by examining individual, systemic, and policy-level determinants. A total of 28 empirical studies published between 2020 and 2025 were systematically analysed using the PRISMA framework. The findings revealed that individual factors such as adequate training, clinical experience, positive attitudes, and self-efficacy significantly enhance the effectiveness of task-shifting. Human resource capacity, particularly the availability of trained non-specialists and consistent supervision, played a crucial role in ensuring service quality. Health system readiness, including functional infrastructure, referral systems, and medical supplies, emerged as critical enablers of successful task-shifting, while deficiencies in these areas limited intervention effectiveness. Furthermore, policy and governance frameworks influenced scalability and sustainability, with weak enforcement and ambiguous role definitions identified as major barriers in Kenya. Overall, the review found that task-shifting can significantly improve healthcare access in rural settings, but only when supported by comprehensive training, adequate system capacity, and strong regulatory frameworks. The study concludes that task-shifting is a viable solution to mitigate specialist shortages, but its success requires a holistic approach that addresses training, supervision, infrastructure, and policy enforcement. It recommends the development of standardised training programs, robust mentorship systems, investments in rural healthcare infrastructure, and the creation and enforcement of clear, context-specific task-shifting policies. These findings are critical for health policymakers and practitioners seeking to enhance equitable healthcare delivery in underserved regions of Kenya.