Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on adopting task shifting as a public health initiative
Recommendation 4
Countries should undertake or update a human resource
analysis that will provide information on the demography of
current human resources for health in both the public and
non-state sectors; the need for HIV services; the gaps in
service provision; the extent to which task shifting is
already taking place; and the existing human resource
quality assurance mechanisms.
Comment: This recommendation places a high value on the need for task shifting to be
country led and country specific in the details of implementation. Establishing the details of
the country context will allow governments to properly assess the potential for implementing
the task shifting approach as one of a range of strategies to strengthen human resources for
health. Particular attention should be paid to identifying the bottlenecks in the delivery system
and the human resources that will be required to rapidly increase access to HIV services.
Many countries have already undertaken a recent human resource analysis and this may
provide the information needed. In other cases, new and additional information may be
required.
Summary of findings
A wide range of factors can influence the way in which a government may wish to implement the
task shifting approach. The key variables can be summarized as follows: the extent of human
resources for health crisis including the demography of current human resources for health; the
HIV burden and the burden of other diseases in the health sector; the bottlenecks and gaps that
exist in the system that are limiting the extent to which services are accessible and equitable; the
nationally endorsed service delivery model; the extent to which task shifting is already taking
place; and progress towards the goal of universal access to HIV services.
Depending on these variables, countries may face a wide range of choices concerning which
types of task shifting practices they wish to adopt and at what scale, and the speed at which they
wish to proceed with implementation.
Although a shortage of human resources for health exists in many countries, the specific nature of
the shortfall and its implications vary widely. For example, Malawi has an overall shortage
affecting every cadre of health worker with an extremely severe shortage of doctors 1 72-74 . Ethiopia
is experiencing a particular shortage of doctors but has a larger number of nurses 1,75 .
In some countries there is an uneven geographical distribution that gives rise to acute shortages
of health workers in some areas, while in others the distribution of the existing human resources
for health between the public and non-state sectors is problematic. The particular composition of
the health workforce in terms of cadres and their scope of practice and the current organization of
the workforce are also relevant. For example, in some countries mid-level cadres of non-physician
clinicians already exist, while in others they do not 1 13 76-80 .
The nature of the HIV epidemic is another factor that can vary. There are notable differences in the
maturity of the epidemic, and in the characteristics of the communities that are most affected,
both within and between countries 81 82 .
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