Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on creating an enabling regulatory environment for implementation
Recommendation 6
Countries should consider adopting a fast-track strategy to
produce essential revisions to their regulatory approaches
(laws and proclamations, rules and regulations, policies and
guidelines) where necessary. Countries could also
simultaneously pursue long-term reform that can support
task shifting on a sustainable basis within a comprehensive
and nationally endorsed regulatory framework.
Comment: This recommendation places high value on balancing the need for quality,
protection and accountability with the urgency of the need to increase access to health
services, including HIV services. Countries can use an incremental approach to produce rapid
revision to the regulatory framework where necessary. Simultaneously, countries can pursue a
full and thorough approach to regulatory reform which can be undertaken at a slower pace.
Summary of findings
Countries that chose to adopt the task shifting approach as a response to severe shortages of
human resources for health alongside a high HIV burden will want to move fast with
implementation. From a pragmatic point of view, the objective is to expand the pool of human
resources for health in order to increase access to a range of health services including those for
HIV. To achieve this aim, while also ensuring the necessary levels of quality, protection and
accountability, appropriate regulation must be put in place at a pace that does not delay the
expansion of service provision any longer than is necessary.
Changes in scope of practice can take place quickly in some cases . However, they may also be
slow because of the policy and legislative processes involved 86 . In such situations there may be
alternative strategies, such as the use of existing public health emergency responses, that take
less time and that countries could use to facilitate the rapid implementation of task shifting.
In some countries, task shifting may already be taking place in an informal capacity as an
emergency response to health workforce shortages 55 56 94 95 . In such cases, countries will need to
consider fast-track strategies which can quickly formalize the evolutions of roles and scopes of
practice that have already been achieved. These strategies could involve relatively small revisions
to policies and guidelines or could call upon regulatory approaches that already exist and are
permissive.
However, more comprehensive reform of a country’s regulatory framework could also have
advantages. Many countries retain models of health-care regulation that no longer provide the
coherence or flexibility required to fully meet the needs of current health-service delivery systems.
The adoption of the task shifting approach could provide an opportunity to adapt regulations in a
way that would help to strengthen not only HIV services but also the wider health-care system. If
task shifting is to be sustained in the long term, comprehensive reform of the regulatory
framework may well be needed.
It is interesting to note that a study undertaken in high-income countries concluded that task
shifting can be developed to the greatest extent if systems have permissive frameworks wherein
the law allows for broad definitions of scopes of practice 98 . For example, the roles and range of
activities of nurses are more extensive in health systems such as that in the United Kingdom
where their scope of practice is defined by law in a broad sense rather than by a list of tasks.
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