Task shifting and innovative medical education--moving outside the box to serve rural Nepal

Health care systems everywhere must tackle the problem of supplying quality health care workers to underserved areas. Except in countries that are both small and wealthy, the traditional methods of medical education and worker deployment have proven widely inadequate--and this is certainly the case in Nepal. We discuss here how alternative approaches to remedy the problem are being undertaken locally. First, we show how the concept of task-shifting to lower level staff has already begun to fill in gaps in the area of emergency obstetric care. In the short- and medium-term, task-shifting is a viable solution to the mal-distribution of health care workers. Second, we give three short case studies that illustrate a small, local organization, Nick Simons Institute, partnering with the government's National Health Training Center to pioneer 'outside the box' alternatives to medical education. These include the design and implementation of novel in-service courses, including CME.