Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on adopting task shifting as a public health initiative
• Task shifting offers opportunities for increasing access to HIV services while maintaining good
quality of care.
• Task shifting can make a positive contribution to other disease programmes and to overall
health systems strengthening
Selected examples of experience/additional resources:
The WHO-Commissioned Study on Task Shifting identified various country experiences where
task shifting is already showing good outcomes in terms of significant increases in the number of
service users receiving treatment with antiretroviral therapy and high levels of service-user
satisfaction.
For example, in Malawi, a critical shortage of human resources, particularly medical doctors, and
a high burden of HIV have made task shifting essential for scale-up of HIV services 47 . Nonphysician
clinicians and nurses prescribe antiretroviral therapy among other services and the
scope of practice of some cadres of community health workers has been extended to allow them
to perform HIV counselling and testing.
Recommendation 2
In all aspects concerning the adoption of task shifting,
relevant parties should endeavour to identify the
appropriate stakeholders, including people living with
HIV/AIDS, who will need to be involved and/or consulted
from the beginning.
Comment: This recommendation places high value on the importance of consultation, active
engagement, partnership building and shared responsibility in the task shifting approach.
Community sensitization and education of service users will also be needed to help task
shifting find acceptance among people living with HIV/AIDS and others with common unmet
health-care needs, the health workforce and the general public.
Summary of findings
Task shifting represents a major change to the way in which health services are delivered by the
workforce and in which service users will experience their health-care provision. Experience has
shown that major change demands broad consultation if it is to be accepted and to succeed 49 50 .
Certainly there are numerous examples of systems failures that can be tracked back to poor
consultation 49 .
The efforts to expand primary health care following the International Conference on Primary
Health Care held in Alma Ata in 1978 were characterized by a lack of proper consultation and
coordination. Analysis of these programmes indicates that their failure to meet expectations was,
in part, the result of a failure to fully engage stakeholders from the outset 51 .
Analysis undertaken as part of the WHO-Commissioned Study on Task Shifting identified the full
range of major stakeholders that may need to be engaged at the country level for the successful
implementation of task shifting. In most cases these can be summarized as bodies that exist to
represent the interests of health professionals; service providers, including both public and nonstate
sector organizations; health workers who may or may not be represented by unions; service
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