Task Shifting - Global Recommendations and Guidelines - unaids

Recommendations on the organization of clinical care services
• Recent documentation of task shifting type III is less plentiful than that available for task
shifting types I and II because there has been less reported experience of type III..
Selected examples of experience/additional resources:
The WHO-Commissioned Study on Task Shifting identifies numerous examples of the creation
and effective deployment of new cadres of community health workers as part of the task shifting
approach in those countries studied.
In Uganda, community health worker have been trained to fulfil a variety of roles in the delivery of
HIV services. Some follow a 12-week course involving 6 weeks of classroom teaching and 6
weeks of clinical clerkship covering a range of theoretical and practical clinical skills related to HIV
services. Others take a 12-day course that prepares them to offer adherence support, group
education and counselling.
In Haiti and Rwanda, community health workers contribute to over half of the HIV-related tasks,
including HIV testing activities, patient visits, management of patients prior to and after initiation of
antiretroviral therapy, prevention of mother-to-child transmission and long-term follow-up of
patients on antiretroviral therapy.
Recommendation 21
People living with HIV/AIDS who are not trained health
workers can be empowered to take responsibility for certain
aspects of their own care. People living with HIV/AIDS can
also provide specific services that make a distinct
contribution to the care and support of others, particularly
in relation to self-care and to overcoming stigma and
discrimination.
Comment: This recommendation places high value on the evidence that good health
outcomes can be achieved when service users are empowered to participate in the
management of their own condition. Self-management also contributes to the rational
redistribution of tasks for HIV services (task shifting IV). The recommendation also recognizes
the value of people living with HIV/AIDS as expert patients and the benefits of peer support in
HIV services.
Summary of findings
Through a logical extension of the task shifting approach, people living with HIV/AIDS can be
empowered to participate in a number of tasks relating to the management of their own condition
and, by doing so, free more of the time of trained health workers. In addition, they have a unique
contribution to make in providing care and support to others through counselling, adherence
support and other services. People living with HIV/AIDS can also make a particular contribution as
trained community health workers (as discussed in Recommendation 20). In these ways, people
living with HIV/AIDS can contribute to the further expansion of the available human resources for
delivering HIV services and to improvements in the quality of care.
There are many studies that describe the involvement of patients in chronic disease management
in high-income countries 244-254 . In particular, self-management plays an important role in the
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