Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on creating an enabling regulatory environment for implementation
Next, the extent to which task shifting practices are already taking place will have a bearing on the
approaches used and the pace at which countries elect to proceed in the implementation of task
shifting as a nationally endorsed strategy to increase access to HIV services.
A wide range of studies indicate that a number of countries already reassign tasks as a result of
shortages in specific cadres of health workers 37 . A recent review confirms that, although current
activities to combat HIV are heavily dependent on physicians, other provider types are already
playing a significant role in various tasks, such as assessing eligibility and initiating antiretroviral
therapy, assessing toxicity and failure, and adherence support 24 . In some countries it is already
standard in antiretroviral therapy, as in other health-service delivery, for non-physician clinicians to
perform the bulk of tasks. For example, Ethiopia, Kenya and Malawi now allow non-physician
clinicians to prescribe antiretroviral therapy 12 .
The WHO-Commissioned Study on Task Shifting finds that task shifting is already nationally
endorsed in Ethiopia and Malawi and is taking place in the non-state sectors with the agreement
of the government in Haiti, Rwanda and Uganda (Annex a). However, there are other countries,
for example those in West Africa, that still maintain an entirely medical doctor-based approach.
Countries undertaking a human resource analysis should also seek to identify the quality
assurance mechanisms that are already in place and where these may need adapting or
strengthening for the successful implementation of the task shifting approach. There is evidence
that there are already quality assurance systems in many countries 50 . However, the nature and
extent of investment in quality assurance will vary from country to country depending on the
specific requirements of each health-care system 66 83 .
Advantages:
• Information obtained through a human resource analysis will aid decision-making for the
adoption of task shifting.
• Undertaking or supplementing the country’s human resource analysis provides an opportunity
to identify and involve appropriate stakeholders from the start of the process.
Uncertainties:
• Accurate data on the demography of human resources for health can be difficult to obtain.
Selected examples of experience/additional resources:
In Ethiopia and Malawi, where task shifting has been implemented successfully by national
authorities the first phase involved the completion by the Ministry of Education and the Ministry of
Health of an analysis of the current human resources for health.
Recommendation 5
Countries should assess and then consider using existing
regulatory approaches (laws and proclamations, rules and
regulations, policies and guidelines) where possible, or
undertake revisions as necessary, to enable cadres of health
workers to practise according to an extended scope of
practice and to allow the creation of new cadres within the
health workforce.
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