Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on the organization of clinical care services
• Task shifting can improve quality of care by organizing the delivery of services in
multidisciplinary teams.
Uncertainties:
• Successful task shifting demands certain preconditions and an enabling environment. See
other Recommendations.
Selected examples of experience/additional resources:
In Ethiopia and Malawi the scope of practice of both non-physician clinicians and of nurses has
been extended to allow both these cadres to prescribe antiretroviral therapy. This represents the
implementation of both task shifting type I and type II. In Haiti and in Rwanda, mid-level cadres of
non-physicians do not exist. Therefore these countries have not adopted task shifting type I but
are extending the scope of practice of nurses to allow prescription privileges. This represents task
shifting type II.
The Integrated Management of Childhood Illness (IMCI) and Integrated Management of Adults
and Adolescent Illness (IMAI) were developed by the World Health Organization to facilitate
decentralized delivery of prevention, care and treatment interventions integrated within existing
health systems 207 42 .
Recommendation 17
Countries should ensure that efficient referral systems are
in place to support the decentralization of service delivery
in the context of a task shifting approach. Health workers
should be knowledgeable about available referral systems
and trained to use them.
Comment: This recommendation gives high value to the importance of having a wellstructured
and efficient referral system to ensure the successful implementation of all types of
task shifting. It recognizes that health workers will face patient needs beyond their levels of
competence or responsibility, which may require consultation with or referral to appropriate
service providers. Health workers should be trained in proper use of referral systems, and
referral systems should be strengthened and adequately resourced.
Summary of findings
Where health services have been decentralized from tertiary care to district hospitals, primary
health centres or the community level, one of the preconditions for success, and for ensuring
quality of care, is an accompanying functional and reliable referral system. This permits health
workers to diagnose, or triage, health-care needs and then ensures that they know who to
consult, and how and where to refer patients promptly for appropriate care if necessary 208-210 .
Results are less satisfactory where links between the cadres of health workers of different levels
of qualification, and between facilities with different levels of expertise, have not been properly
established 211 212 .
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