Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on the organization of clinical care services
dispensing of drugs prescribed by a qualified provider; and tasks related to the prevention of
mother-to-child transmission. Community health workers are also trained to work in supportive
services for HIV care, including as X-ray technicians, laboratory assistants, pharmacy assistants
and data clerks.
The study findings include data to support the position that task shifting that involves community
health workers as part of a team for the delivery of HIV services is both safe and effective. The
involvement of community health workers also facilitates the provision of a number of services,
such as adherence and psychosocial support, that are not feasible using a clinic-based
approach alone.
Furthermore, people living with HIV reported a high level of satisfaction with the health care they
were receiving from community health workers. In a survey of 200 people living with HIV, the great
majority were satisfied or extremely satisfied with their assigned community health worker.
The WHO-commissioned study on task-shifting also included focus groups and qualitative
interviews with over 400 community health workers in Haiti to attempt to understand their
attitudes, expectations and understanding of their role in the health care in their communities.
Similar research was conducted in Ethiopia and Rwanda. Community health workers expressed a
willingness to assume new and extended tasks and more specialist cadres, such as nurses and
doctors, generally supported the role of community health workers as integral to their own duties
and recognized that the presence of community health workers allowed them to spend time on
more complicated tasks.
A consultation with people living with HIV/AIDS, undertaken as part of the WHO Commissioned
Study on Task Shifting, concluded that people living with HIV/AIDS have an important role to play
as trained community health workers. Drawing from their own personal experience, they can
make a particularly important contribution to addressing issues such as disclosure, prevention,
self-care, adherence and stigma and discrimination. People living with HIV/AIDS often show a
preference for community health workers who are also living with HIV/AIDS.
Advantages:
• The deployment of community health workers further extends the rational redistribution of
tasks.
• Community health worker programmes make use of underutilized human resources.
• Shorter, task-specific training for community health workers facilitates rapid recruitment and
deployment.
• Task shifting involving community health workers can make a major contribution to the
decentralization of HIV services to rural areas and so bring health services closer to people
living with HIV/AIDS and other patients.
• Community health workers can help expand human resource for health both at the facility and
the community level for HIV services and other health-care services.
• The inclusion of community health workers in health teams allows frequent service-user
interaction at the community level, which improves adherence, patient follow-up and
psychosocial support.
Uncertainties:
• Essential support systems, including training, supervision and referral systems, may not be in
place or functioning well enough.
• Strong planning and monitoring is needed to ensure an efficient system as a wide variety of
cadres and roles poses challenges for coordination.
• The involvement of community health workers is unlikely to be sustainable without established
remuneration mechanisms.
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