Task Shifting - Global Recommendations and Guidelines - unaids

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Preface There is international consensus that without urgent improvements in the performance of health systems, including significant strengthening of human resources for health, the world will fail to meet the Millennium Development Goals for health or to achieve universal access to HIV services by 2010. More resources are needed. But we must also seek innovative ways of harnessing and focusing both the financial and the human resources that already exist. When I took office I announced that primary health care would be firmly at the heart of my agenda for the World Health Organization (WHO). This is nothing new. The WHO Alma Ata Declaration on Primary Health Care of 1978 promoted the decentralization of services among communities in order to achieve greater equity in access to health care. We now have powerful new drugs and other technologies that can support the attainment of the highest possible level of health. We also now share the recognition that health and development are interlinked and enjoy an unprecedented level of political commitment in the face of global health challenges, in particular the HIV epidemic. The task shifting approach represents a return to the core principles of health services that are accessible, equitable and of good quality. These recommendations and guidelines on task shifting provide a framework that is informed by all we now know about the ways in which access to health services can be extended to all people in a way that is effective and sustainable. It is for these reasons that I see task shifting as the vanguard for the renaissance of primary health care. The recommendations and guidelines are fuelled with the sense of urgency that is needed to respond to the HIV epidemic and to the crippling health workforce shortages that exist in many countries. These two interlinked emergencies have provided the impetus for the formulation of this new framework for the strategic delivery of health services. But it is an approach that also offers long-term potential for all primary health-care services and for overall health systems strengthening. Dr Margaret Chan Director-General of the World Health Organization
Contents Preface............................................................................................................................................................................. Executive Summary...............................................................................................................................................2 Summary of recommendations.....................................................................................................................3 Background................................................................................................................................................................6 Scope..............................................................................................................................................................................9 Summary of methods........................................................................................................................................11 Recommendations on adopting task shifting as a public health initiative Recommendation 1.......................................... 14 Recommendation 2.......................................... 16 Recommendation 3.......................................... 17 Recommendation 4.......................................... 19 Recommendations on creating an enabling regulatory environment for implementation Recommendation 5.......................................... 20 Recommendation 6.......................................... 23 Recommendations on ensuring quality of care Recommendation 7.......................................... 24 Recommendation 8.......................................... 26 Recommendation 9.......................................... 28 Recommendation 10....................................... 30 Recommendation 11....................................... 31 Recommendation 12....................................... 33 Recommendations on ensuring sustainability Recommendation 13....................................... 34 Recommendation 14....................................... 35 Recommendation 15....................................... 37 Recommendations on the organization of clinical care services Recommendation 16....................................... 38 Recommendation 17....................................... 40 Recommendation 18....................................... 41 Recommendation 19....................................... 43 Recommendation 20....................................... 45 Recommendation 21....................................... 48 Recommendation 22....................................... 49 Annexes 1. HIV clinical tasks by health worker cadres ........................................................................................51 2. Reference List.....................................................................................................................................................64 3. Methodology........................................................................................................................................................70 4. Guiding principles for country adaptation and implementation..............................................76 5. Monitoring and evaluation ..........................................................................................................................78 6. Definitions..............................................................................................................................................................79 7. Technical experts and stakeholders........................................................................................................82 Annexes available in electronic form (CD attached) a. WHO-Commissioned Study on Task Shifting b. Table of evidence c. Declarations of conflicts of interest d. Global cost estimate for the task shifting approach
Page 1 and 2: treat train retain HIV/AIDS Task Sh
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Page 7 and 8: summary of recommendations Summary
Page 9 and 10: Summary of recommendations E. Recom
Page 11 and 12: ackground The plan is an important
Page 13 and 14: scope Scope These recommendations a
Page 15 and 16: summary of methods Summary of Metho
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Annex 1 Annex 1 HIV clinical tasks
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Annex 1 Manage STIs X X X Assess fa
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Annex 1 Provide co-trimoxazole prop
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Annex 1 e. Supervision MD NPC N CHW
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Annex 1 b. Manage TB Coinfection MD
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Annex 1 Provide supportive care to
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Annex 1 Counsel on special nutritio
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ANNEX 2 1 WHO. The World Health Rep
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ANNEX 2 94 Akakpo M. Processus d’
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ANNEX 2 180 Ensor T, Savelyeva L. I
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ANNEX 3 shifting approach for the d
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ANNEX 3 The country studies were de
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annex 3 Additional information A to
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annex 4 Learning by doing Above all
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annex 6 Annex 6 Definitions Accredi
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annex 6 Registration Official recor
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annex 7 Dr Kevin De Cock, Director,
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annex 7 Dr Adele Webb, Executive Di
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Health Systems and Services (HSS) W
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