Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on ensuring quality of care
Recommendation 10
Training programmes and continuing educational support for
health workers should be tied to certification, registration
and career progression mechanisms that are standardized
and nationally endorsed.
Comment: This recommendation places high value on the need for mechanisms that can
establish the ability of health workers to safely and effectively perform the tasks for which they
have been trained and for mechanisms that can maintain overall responsibility for their
conduct. In combination with career pathways, all of these can contribute to health workforce
motivation and retention.
Summary of findings
A health worker who participates in training or continuing education programmes cannot
automatically be assumed to have mastered the skills that the programme was intended to
impart. Some form of standardized and structured evaluation is needed to establish and
recognize the ability of health workers to perform against competency-based standards 125 126 127 .
This can be achieved through certification, which can include direct observation of health worker
performance by mentors or supervisors at the facility where they work, as well as skills-based
assessments or examinations.
Equally important is the regulation of health workers by means of a registry, overseen by licensing
or regulatory bodies. Registration legitimizes qualified health workers and gives them formal
permission to practise. It also allows for tracking the training that each health worker has
completed and any certification that they have attained. This provides a means by which to
maintain overall responsibility for the conduct of practising health workers and can help determine
the need for additional recruitment to meet service delivery bottlenecks 126 .
There are various studies that examine quality-monitoring mechanisms within the context of
healthcare delivery, as well as some data related to their use in support of measuring health
worker proficiency to deliver HIV services 50 120 127 . These show that certification is one pathway to
improve the quality of the training and continuing professional development that health workers
receive, and to improve their overall effectiveness. Certification has also been used to assess the
gaps in knowledge and skills that are necessary for the delivery of quality HIV services, and to
orient continuing professional development activities to address those gaps 128 129 .
Finally, certification is a means of heightening recognition of health workers. This has proved to
bring considerable benefits in the case of community health workers that are being newly
integrated into health systems. Certification in these cases has resulted in improved support for
community health workers by established cadres of health professionals and has won confidence
among the communities they serve 114 130 131 132 .
Relevant stakeholders (e.g. governments, medical or nursing boards, professional associations
and academic institutions) are generally tasked with establishing certification mechanisms, which
include developing, preparing, administering and evaluating certification examinations or practical
skills assessments that evaluate whether trainees have mastered the core knowledge and skills
relevant to perform their assigned tasks 133-136 .
Various studies have shown that the opportunity for career progression is important for retaining
health workers as it offers both a professional and a financial incentive. Ensuring that the
successful completion of training and continuing education are tied to career paths can help to
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