Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on the organization of clinical care services
Summary of findings
A wide range of sources, including the WHO-Commissioned Study on Task Shifting, observe that
a range of different task shifting practices are currently being implemented in a variety of settings
for the delivery of HIV services 12 Annex a .
The evidence supports a broad categorization of task shifting practices into four types, as follows:
Task shifting I – The extension of the scope of practice of non-physician clinicians in order to
enable them to assume some tasks previously undertaken by more senior cadres (e.g. medical
doctors).
Task shifting II – The extension of the scope of practice of nurses and midwives in order to enable
them to assume some tasks previously undertaken by senior cadres (e.g. non-physician
clinicians and medical doctors).
Task shifting III – The extension of the scope of practice of community health workers (often called
non-professional health workers or lay providers), including people living with HIV/AIDS, in order
to enable them to assume some tasks previously undertaken by senior cadres (e.g. nurses and
midwives, non-physician clinicians and medical doctors).
Task shifting IV – People living with HIV/AIDS, trained in self-management, assume some tasks
related to their own care that would previously have been undertaken by health workers.
There is also potential for task shifting that involves other cadres that do not traditionally have a
clinical function, for example, pharmacists, pharmacy technicians or technologists, laboratory
technicians, administrators and records managers.
The cadre that assumes the new task, not the cadre that is relieved of the task, is the defining
factor for task shifting types. For example, any extension of the scope of practice of nurses and
midwives is defined as task shifting type II.
See Annex 1 for a full list of identified tasks and groups of services.
The WHO-Commissioned Study on Task Shifting observed task shifting types I, II, III and IV, as
well as some task shifting involving other cadres such as pharmacists and laboratory technicians,
taking place in a variety of combinations in Ethiopia, Haiti, Malawi, Namibia, Rwanda and Uganda
Annex a
. The study also identified further options relating to the health-care delivery level at which the
task shifting practices can take place. Task shifting involving nurses and community health
workers was seen to produce good health outcomes and high levels of service-user satisfaction
at the tertiary level (specialized hospital or facility), the secondary level (district hospital or district
outpatient facility) and at the primary level (care being delivered at a health centre or non-facilitybased
care being delivered at the community level). These findings are in keeping with one of the
principles of good chronic care; that the organization of service in a diverse clinical team
contributes to better outcomes than service delivery by doctor only.
The experience of countries shows that task shifting can be implemented successfully in a variety
of ways. Service delivery approaches need to be appropriate to the national context, the health
systems and the existing mix of providers 12 . Therefore, any decision about which task shifting
type to employ should be made at the country level.
Advantages:
• The task shifting approach offers a wide range of options for the delivery of HIV services,
which can be refined to suit specific country situations.
• Task shifting at the tertiary, secondary and primary care levels can make efficient use of
available human resources and provide good care.
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