An updated framework for task shifting and sharing: refining the SHIFT-SHARE based on stakeholder feedback from India

Shortages of health care providers necessitate task shifting and sharing (TS/S), yet few implementation frameworks guiding these strategies exist. In 2023, we developed the first iteration of the Strategic Healthcare Implementation Framework for Task Shifting, Sharing, and Resource Enhancement (SHIFT-SHARE), a six-stage cyclical framework drawing on change management theories and implementation science. Here we present SHIFT-SHARE 2.0, updated to incorporate stakeholder consultations in India, where we ran eight focus group discussions with 35 stakeholders (November 2023 to September 2024), including health care staff, organisational leaders, academics, and students. Participants reviewed SHIFT-SHARE materials beforehand and gave feedback on its accessibility, terminology, structure, and utility, after which we mapped the framework's strengths, weaknesses, and required modifications through thematic analysis. Stakeholders valued SHIFT-SHARE's visual clarity and comprehensiveness, while identifying changes to make its language more accessible, restructuring risk assessment as a continuous process, adding workforce incentivisation as a core consideration, and reconceptualising the framework's logic model to represent continuous cycles, terminating loops, and contingency exits. We also propose implementation support tools, including a term of reference document and a workbook of question-based prompts. The SHIFT-SHARE 2.0 addresses stakeholder-identified barriers to TS/S and may help make implementation planning more systematic, responding to the World Health Organization's calls for TS/S-specific frameworks. Further validation across diverse contexts will be needed to assess its broader utility.