Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on ensuring quality of care
workers to ensure that they are adequately equipped to perform their designated tasks safely and
effectively. This can facilitate setting training and evaluation criteria.
Analyses of literature related to human resource management and empirical evidence gleaned
from public health interventions in which human resource management processes are fully
integrated, reveal that role definition represents the basic organizing element in any organization.
Role definition provides shared understanding of tasks and responsibilities, levels of authority to
make decisions within the health team (including when to refer patients to a more appropriate
cadre) and what skills and qualifications are necessary to carry out the responsibilities that are
assigned 66 101 .
Defining competencies helps ascertain both the behavioural and technical skills that are needed
to meet the requirements of the job 92 . This improves recruitment procedures by making it easier
to identify the desired qualities in candidates. The setting of clear recruitment criteria provides the
basis for developing induction and training programmes to equip the practitioner with the
necessary competencies.
The definition of required competencies also makes it possible to evaluate and credit the
experience-based competencies of community members who have already been providing
services 66 .
Studies of community health worker programmes have identified a number of factors that are
associated with improving the success of implementation and these include the need for effective
selection and recruitment processes 66 96 97 99 100 .
A number of publications have looked specifically at how employers can create the right
conditions to support recruitment, training and the retention of employees. These documents
have distilled evidence from a range of projects and offer guidance on what factors to address
and how to address them 105-107 .
Evaluation of a number of HIV/AIDS projects in Africa have identified the same factors that are
seen as important to address in the general literature as discussed above. In addition the WHO
publication offering guidance on the implementation of community-based HIV care in resourceconstrained
settings offers comprehensive suggestions across the continuum of care delivery 110 .
Advantages:
• Well-defined scopes of practice and the clear identification of associated competency levels
support efficient and coherent human resource management.
• Clear recruitment criteria ensure that tasks are only undertaken by those with the appropriate
behavioral and technical skills.
• Clear recruitment criteria support the development of appropriate training.
Uncertainties:
• Not all employers have well-developed and resourced human resource processes capable of
supporting standardized and systematic approaches to recruitment and training.
• Not all staff who are involved in the processes have the necessary competencies to undertake
efficient, effective and equitable human resource processes.
Selected examples of experience/additional resources:
The WHO-Commissioned Study on Task Shifting documents the work undertaken in Ethiopia to
define the roles of new cadres of community health workers (called Health Extension Workers)
and the identification of related training and recruitment criteria and job descriptions Annex a .
Generic guidance on defining core competences for HIV service delivery is also available from a
prior WHO consultation 92 .
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