Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on ensuring quality of care
Recommendation 12
Countries should ensure that the performance of all cadres
of health workers can be assessed against clearly defined
roles, competency levels and standards.
Comment: Assessment provides the means to ensure that agreed standards for quality of
care and for the recruitment, training and retention of health workers are met. Roles,
competency levels and standards must be clearly defined and communicated so that the
performance of health workers under the task shifting approach can be properly evaluated.
However, achieving health outcomes is dependent on the contribution of many workers and
therefore any assessment process should be undertaken within the context of health-care
teams.
Summary of Findings
Setting standards against which desired outcomes can be assessed is essential to the success
of the task shifting approach. If quality of care is to be ensured, health workers must perform their
tasks in a way that meets agreed standards or technical expectations. The assessment process
provides the means by which to verify that standards are being delivered and maintained 145 .
Performance standards have been shown to provide a way to monitor the quality and the
effectiveness of care. Studies have also found that performance standards can help to create an
environment supportive of continuous quality improvement 146 147 .
Competency-based standards serve a different purpose. These provide health workers and their
supervisors with a clear understanding of what indicators will be used to measure their job
performance. Competency-based standards can also contribute to improving the technical
quality of care delivery by individual health workers, health-care teams and health facilities.
However, if such standards are to be effective, they must be fully communicated and promoted
so that all parties know what is expected of them 148-150 .
In general, assessment makes it possible to collect and compare data that will help to identify
and then apply “best practices” in the delivery of health services 150 151 . Assessment also has the
potential to create a work climate that motivates health workers and improves their performance.
However, these outcomes are only likely to be achieved if assessment processes are constructive
and are linked to recognition and career progression 152 .
Advantages:
• Assessment supports the delivery of agreed standards and highlights the need to take
corrective action if necessary. This may involve the redefinition of roles, competency levels and
standards.
• Well-defined roles, competency levels and standards that are fully communicated make
assessment an effective continuing quality improvement mechanism.
Uncertainties:
• Existing data collection and monitoring systems in resource-constrained countries are, in
many cases, not geared toward tracking quality assurance indicators.
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