Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on the organization of clinical care services
Advantages:
• Task shifting to non-physician clinicians increases access to services and makes efficient use
of the available human resources by freeing some of the time of medical doctors to
concentrate on complex cases.
• The deployment of non-physician clinicians can contribute to the decentralization of services
to rural and marginalized communities.
• Non-physician clinicians are less likely to migrate than medical doctors.
Uncertainties:
• Non-physician clinicians may lack a clear path for career progression.
• If posted to hard-to-reach areas, structured continuous training and supportive supervision
may be difficult to ensure.
Selected examples of experience/additional resources:
Mullan F. and Frehywot S. have recently undertaken an extensive study of the deployment of nonphysician
clinicians throughout sub-Saharan Africa 80 .
The WHO-Commissioned Study on Task Shifting describes the role of non-physician clinicians in
the delivery of HIV services in Ethiopia, Malawi and Uganda Annex a .
Recommendation 19
Nurses and midwives can safely and effectively undertake a
range of HIV clinical services (as outlined in Annex 1) in the
context of service delivery according to a task shifting
approach.
Comment: This recommendation places a high value on the evidence from selected countries
that a wide range of HIV clinical services can be safely and efficiently moved from clinicians to
nurses and midwives. In situations where a shortage of clinicians creates a bottleneck in the
delivery of HIV services, task shifting of this type (task shifting II) can make a significant
contribution to increasing access. Appropriate training, regular supportive supervision and
well-functioning referral systems are essential preconditions for the success of the task
shifting approach.
Summary of findings
The global deficit of doctors, nurses and midwives is at least 2.4 million 1 . According to the
available data, many of those countries that are facing a generalized HIV epidemic also have
acute shortages of human resources for health including shortages of nurses and midwives.
However, the overall composition of a country’s health workforce usually includes a larger number
of nurses than of medical doctors or non-physician clinicians. For example, the ratio of nurses to
doctors in South Africa and in the United States of America is approximately 5:1. In Malawi the
ratio is around 25:1 1 .
Particular bottlenecks that have been identified in the efforts to expand provision of HIV services
include the initiation and prescription of first-line antiretroviral therapy and other tasks that are
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