Task Shifting - Global Recommendations and Guidelines - unaids

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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 16
Recommendations on adopting task shifting as a public health initiative users including people living with HIV/AIDS; and relevant government and administrative departments. Task shifting must also win acceptance among the general public, who will need reassurance that changes to their health services will bring benefits for individuals and communities. Furthermore, service users need information about how to engage with new service delivery models. Full and open consultation that engages stakeholders at all levels as advocates for change forms the bedrock upon which public education campaigns can be built. Advantages: • Consultation enhances ownership. • Consultation contributes to harmonization, alignment and sustainability. • Consultation contributes to wider advocacy and facilitates communication with the general population. Uncertainties: • Consultation can be resource intensive and time consuming. Selected examples of experience/additional resources: Evidence from the WHO-Commissioned Study on Task Shifting identified the importance of consultation for the effective implementation of task shifting Annex a . In Malawi, a lack of adequate consultation with the regulatory bodies when the government created a new cadre of community health workers in the 1970s resulted in a refusal by the Medical and Nursing Council to recognize their functions. On the other hand, proper consultation with the regulatory bodies on plans to delegate the prescription of antiretroviral therapy to nonphysician clinicians and nurses created the right environment. The Medical Council approved the extension of the scope of practice of non-physician clinicians accordingly. In Ethiopia, the creation of a new cadre was preceded by consultation with all stakeholders involved in regulating health workers. The positive outcome was the establishment of the new cadre within the civil service. Recommendation 3 Countries deciding to adopt the task shifting approach should define a nationally endorsed framework that can ensure harmonization and provide stability for the HIV services that are provided throughout the public and nonstate sectors. Countries should also explore a framework for the exploration of task shifting to meet other critical public health needs. Comment: This recommendation recognizes the valuable contribution that can be made by a variety of health-care providers in both the public and non-state sectors, but also stresses the unique position of government to oversee the country’s public health. 17
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Page 5 and 6: Contents Preface...................
Page 7 and 8: summary of recommendations Summary
Page 9 and 10: Summary of recommendations E. Recom
Page 11 and 12: ackground The plan is an important
Page 13 and 14: scope Scope These recommendations a
Page 15 and 16: summary of methods Summary of Metho
Page 17 and 18: summary of methods A total of 167 e
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Page 25 and 26: Recommendations on creating an enab
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Page 29 and 30: Recommendations on ensuring quality
Page 39 and 40: Recommendations on ensuring sustain
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Page 43 and 44: Recommendations on the organization
Page 55 and 56: Annex 1 Annex 1 HIV clinical tasks
Page 57 and 58: Annex 1 Manage STIs X X X Assess fa
Page 59 and 60: Annex 1 Provide co-trimoxazole prop
Page 61 and 62: Annex 1 e. Supervision MD NPC N CHW
Page 63 and 64: Annex 1 b. Manage TB Coinfection MD
Page 65 and 66: Annex 1 Provide supportive care to
Page 67 and 68: Annex 1 Counsel on special nutritio
Page 69 and 70: ANNEX 2 1 WHO. The World Health Rep
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ANNEX 2 94 Akakpo M. Processus d’
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ANNEX 2 180 Ensor T, Savelyeva L. I
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ANNEX 3 shifting approach for the d
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ANNEX 3 The country studies were de
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annex 3 Additional information A to
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annex 4 Learning by doing Above all
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annex 6 Annex 6 Definitions Accredi
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annex 6 Registration Official recor
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annex 7 Dr Kevin De Cock, Director,
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annex 7 Dr Adele Webb, Executive Di
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Health Systems and Services (HSS) W
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