Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on ensuring quality of care
retain skilled workers in the health system and contribute to recruitment among the more highly
qualified cadres as health workers add to their skill set and seek promotion.
Advantages:
• The use of certification mechanisms, such as practical skills-based assessments or exams,
provides a means of identifying gaps in the knowledge and skills of health workers.
• Registration of health workers, and especially non-professional health workers, legitimizes a
cadre and allows for a licensing and/or regulatory body to maintain institutional responsibility
for the cadre.
• Career frameworks can assist in workforce planning.
Uncertainties:
• While there are abundant data reflecting the positive impact of certification of professional
health workers in high-income countries as a means of continuing professional development
and quality assurance, there is a general dearth of such data from resource-constrained
countries, and far fewer related to the field of HIV medicine.
Selected examples of experience/additional resources:
Malawi links specific in-service training for the delivery of HIV services to a standardized and
nationally endorsed process for certification. Non-physician clinicians and nurses undergo a fiveday
training in the initiation of antiretroviral therapy, which is followed by a certification exam. The
Medical Council or Nursing Council then approves the extension of the scope of practice of each
non-physician clinician or nurse who successfully completes the exam so that they can prescribe
antiretroviral therapy.
Recommendation 11
Supportive supervision and clinical mentoring should be
regularly provided to all health workers within the structure
and functions of health teams. Individuals who are tasked
with providing supportive supervision or clinical mentoring
to health workers to whom tasks are being shifted should
themselves be competent and have appropriate supervisory
skills.
Comment: This recommendation gives high value to the importance of having a structured
support system in place for the successful implementation of task shifting, specifically
supportive supervision. This recommendation recognizes that task shifting will create new and
additional responsibilities for supervision. These additional responsibilities should be reflected
in job descriptions and scopes of work. The need for supportive supervision may require the
deployment of additional health workers. Concerted efforts will be needed to provide on-site
or technology-facilitated supportive supervision for health workers in rural areas.
Summary of findings
It is widely recognized that support for health workers through supervision, mentoring and
teamwork improves the quality of care across the spectrum of health services 65 66 96 97 99 100 138 .
31