Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on creating an enabling regulatory environment for implementation
The research conducted in Ethiopia, Malawi, Namibia and Uganda found that all four countries
had conducted some type of regulatory assessment and analysis to determine the adequacy of
the existing regulations to support task shifting. The assessments were primarily guided by the
unit in charge of HIV/AIDS in the Ministry of Health. The assessments had commonly focused on
areas such as scope of practice; standards of care; pre-service and in-service training;
credentialing (including types of degrees and certification); labour issues such as salaries and
working conditions and career development; and supervision and mentoring.
The research found that the countries studied had modified certain regulatory elements to a
varying degree depending on the type of task shifting and the specific services to be provided via
new or existing health-care providers. The approaches also varied based on the extent to which
the government guided and controlled the processes.
All the countries that were documented stressed the importance of ensuring that regulatory
changes were undertaken in accordance with other national policies that effect the development
of new roles for health workers, or the establishment of new cadres, for example, policies around
labour, financing and decentralization.
Advantages:
• By assessing the current regulatory elements in relation to expanding the role of current
providers or establishing a new cadre, countries may find that they have sufficient scope to
implement task shifting within their existing laws and proclamations, rules and regulations,
policies and guidelines.
• If revision is needed, assessment can ensure focus on exactly what regulatory elements need
to be adjusted.
Uncertainties:
• Limited information is available on the association between regulation and the quality and
safety of health-care services.
Identified examples of experience/additional resources:
The WHO-Commissioned Study on Task Shifting defines a regulatory framework to support task
shifting, which has been developed based on the mapping of country experience that was
undertaken as part of the study.
In Malawi, government officials identified the laws and the regulations that made task shifting from
medical doctors and non-physician clinicians to nurses problematic in the country and proceeded
to make changes to the Ministry of Health’s antiretroviral therapy implementation guidelines.
Later, the country amended the regulations implementing the Nurses and Midwives Practice Act
and the Pharmacy, Medicines, and Poisons Act to allow for nurses to initiate antiretroviral therapy
via prescription.
In Ethiopia, the government held a series of meetings for government staff, including the external
stakeholders within other line ministries, and nongovernmental stakeholders to discuss the
creation of a new cadre called Health Extension Workers. A primary goal was to establish an
appropriate legal basis for this new cadre so that it could successfully be integrated into the civil
service system and the existing delivery and regulatory system.
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