Task Shifting - Global Recommendations and Guidelines - unaids

ackground
The plan is an important component of WHO’s overall efforts to strengthen human resources for
health and to promote comprehensive national strategies for developing human resources across
different disease programmes. It is also part of WHO’s efforts to promote universal access to HIV
services.
“Treat” includes a package of HIV treatment, prevention, care and support services for health
workers who may be infected or affected by HIV and AIDS. “Retain” involves strategies to enable
health systems to retain workers, including through financial and other incentives, occupational
health and safety and other measures to improve the workplace, as well as initiatives to reduce
the migration of health workers.
“Train” includes exploring measures to raise recruitment rates and expand pre-service and inservice
training. However, it takes six years to train a new doctor and three or four to train a nurse.
Waiting for enough new health workers to graduate through the conventional systems will mean
lengthy delays in the provision of urgently needed HIV services. Alongside strategies to increase
the numbers of well-qualified health workers in the system, countries also need to make more
efficient use of the human resources currently available and find ways to expand the total health
workforce fast enough to respond to the HIV epidemic. Therefore, “Train” also explores the
potential for increases in efficiency and a rapid expansion of the pool of human resources for
health through task shifting.
Task shifting: the rational redistribution of tasks among health workforce teams
Task shifting is the name now given to a process whereby specific tasks are moved, where
appropriate, to health workers with shorter training and fewer qualifications. By reorganizing the
workforce in this way, task shifting can make more efficient use of existing human resources and
ease bottlenecks in service delivery. Where further additional human resources are needed, task
shifting may also involve the delegation of some clearly delineated tasks to newly created cadres
of health workers who receive specific, competency-based training.
Task shifting is not new. There are many examples of this type of delegation for delivering a range
of health services, including those for HIV 4 . In a number of high-income countries, such as
Australia, the United Kingdom of Great Britain and Northern Ireland and the United States of
America, the role of nurses has been extended in some settings to include the prescription of
routine medication, and people living with HIV/AIDS have been empowered to participate in the
management of their own chronic condition and to support others as part of expert patient
programmes 4-9 . Task shifting of various kinds is also currently being implemented in some
resource-constrained countries as a response to acute shortages of human resources for health
and particularly amid generalized HIV epidemics. In Malawi and Uganda, the basic care package
for people living with HIV/AIDS has been designed to be delivered by non-specialist doctors or
nurses supported by community health workers and people living with HIV/AIDS. Similarly,
Ethiopia has implemented a plan to hire community health workers to expand the current
workforce delivering HIV services. In other countries, there are examples of task shifting being
implemented in pilot projects, often with the involvement of nongovernmental organizations Annex a .
The WHO global recommendations and guidelines
The WHO global recommendations and guidelines on task shifting have been developed to
provide an authoritative framework that can help support and guide widespread implementation
in those countries that choose to adopt the approach as a national strategy for organizing the
health workforce. They aim to bring clarity to the task shifting experience and to identify and