Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on ensuring quality of care
The WHO-Commissioned Study on Task Shifting found that several countries had chosen to
apply a fast-track strategy to regulate task shifting. The approaches they used varied according
to the extent to which the structure of government allowed a rapid response during periods of
emerging public health problems. For example, a country’s previous experience with other
emerging public health needs, such as tuberculosis and malaria, may have set precedence for
current and future procedures. In addition, the availability of national emergency response
procedures within a country, for example Ministry of Health authority to establish new cadres
during periods of national emergency, were often cited as important factors that made a fast-track
approach feasible Annex a .
Certain countries have initiated mid-term to long-term strategies in tandem with a fast-track
strategy. These efforts were generally guided by the need to assure sustainability of providers and
services as well as to assure quality and safety. As part of the process for longer-term reform,
governments were engaged in identifying, assessing and analysing regulations and mapping the
existing regulatory system to identify gaps and areas in need of development, revision or
clarification. Several countries had established new cadres to delivery necessary HIV services
based on a prior analysis of the regulatory system and had introduced modifications to
accommodate these new cadres within the existing health-care system.
Advantages:
• Countries adopting a fast-track solution will have additional time to plan and implement a
longer-term solution to refine health-care regulation.
• Most countries have used some type of fast-track approach for other public health
emergencies and may be able to draw on those experiences to guide the initial stages of task
shifting.
• Existing government policies may be sufficient to mobilize the public or non-state sector to
deliver necessary services based on nationally accepted standard practice guidelines and
procedures.
Uncertainties:
• Fast-track solutions to the regulation of task shifting may create unintended consequences if
maintained for extended periods.
• Longer-term approaches to achieve comprehensive regulatory reform may take considerable
time and investment.
Selected examples of experience/additional resources:
The WHO-Commissioned Study on Task Shifting has documented the regulatory approaches
used by selected countries, including both fast-track and comprehensive reform, to
accommodate task shifting. The study also presents a model that describes various levels of a
regulatory framework for task shifting.
Recommendation 7
Countries should either adapt existing or create new human
resource quality assurance mechanisms to support the task
shifting approach. These should include processes and
activities that define, monitor and improve the quality of
services provided by all cadres of health workers.
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