Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on ensuring quality of care
Uncertainties:
• Most of the robust studies of quality assurance mechanisms have not been conducted with a
specific HIV focus.
• The majority of studies of quality assurance mechanisms, including Continuous Quality
Improvement, have been conducted in the United States of America and other high-resource
countries.
Selected examples of experience/additional resources:
The WHO global review of quality assurance in health-care services gives examples from around
the world of quality structures and processes that might inform local improvement of health
services, especially in resource-constrained countries 85 .
A range of summary reports on how countries have implemented quality assurance programmes
is contained in the January 1999 edition of the QA Briefing 83 . The Center for Human Services has
also produced a summary document that highlights the key elements of a comprehensive quality
assurance programme 102 .
Rwanda has published a list of case study examples of broader-based quality improvement
initiatives 103 .
The Ministry of Health in Ethiopia has put in place a range of quality assurance measures in
relation to the delivery of antiretroviral therapy and has produced a succinct document that
highlights these 104 .
Recommendation 8
Countries should define the roles and the associated
competency levels required both for existing cadres that are
extending their scope of practice, and for those cadres that
are being newly created under the task shifting approach.
These standards should be the basis for establishing
recruitment, training and evaluation criteria.
Comment: This recommendation indicates the importance of defining what tasks can be
performed by each cadre of health worker under a task shifting approach and what
competencies each health worker will need to undertake those tasks safely, efficiently and
effectively. Clear criteria and recognized standards provide a basis against which job
descriptions can be developed, potential applicants can be judged, appropriate training can
be developed and evaluation can take place. Specific measures should be developed for the
recruitment and rapid assimilation of health workers with relevant practical experience.
Summary of findings
Task shifting may involve revisions to the scope of practice of existing cadres of health workers
and the development of new scopes of practice for any new cadres that may be established
under the task shifting approach. The clear definition of roles is the basis for organizing the
redistribution of tasks and is essential if services are to function in a coherent and effective way.
Equally important is the identification of exactly what skills and experience are required in health
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