Distinguishing task shifting from task sharing through the delegating provider's presence or absence: proposed operational definitions.

Task shifting and task sharing are strategies for redistributing healthcare responsibilities to optimise healthcare services. The World Health Organization (2008) framed 'shifting' as the delegation of tasks from higher- to lower-qualified workers, while subsequent scholarship characterised 'sharing' as collaborative, team-based redistribution. However, the two approaches are often used interchangeably in literature and by practitioners. Drawing on interviews and observations across 16 Indian organisations working in primary healthcare, mental health, and emergency medical services, we identified two types of operational ambiguities: organisations simultaneously employed both strategies for different tasks within the same service and also demonstrated practices that did not match their design intent or initial appearances. Based on these, we reiterate the importance of classifying task redistribution (Shifting OR Sharing) at individual task levels, consistent with the task-specific wording of conventional definitions, and additionally propose a new operational criterion: whether the delegating provider is functionally present or absent during task execution. We suggest revised working definitions incorporating this criterion as a hypothesis for prospective testing, and invite the global health community to validate these for clearer implementation, evaluation, and policy.