Task Shifting - Global Recommendations and Guidelines - unaids

HEADING executive Summary
Executive summary
The global recommendations and guidelines on task shifting propose the adoption or expansion
of a task shifting approach as one method of strengthening and expanding the health workforce to
rapidly increase access to HIV and other health services. Task shifting involves the rational
redistribution of tasks among health workforce teams. Specific tasks are moved, where
appropriate, from highly qualified health workers to health workers with shorter training and fewer
qualifications in order to make more efficient use of the available human resources for health.
Reorganization and decentralization of health services according to a task shifting approach can
help to address the current shortages of health workers. Such shortages are particularly acute in
countries that face a high HIV burden. However, task shifting alone is not expected to resolve the
health workforce crisis. The recommendations and guidelines stress that task shifting should be
implemented alongside other strategies that are designed to increase the total numbers of health
workers in all cadres. They also stress that task shifting is proposed as an efficient approach but
one that will require significant investment and that should not be seen as a substitute for other
investments in human resources for health.
The recommendations and guidelines have been developed over a period of one year through a
process of country consultation, extensive evidence gathering (including specially commissioned
research to address knowledge gaps), and broad consultation among a wide range of experts
and stakeholders. The outcome is a set of 22 recommendations that provide overall guidance to
those countries that are considering adopting or extending a task shifting approach. The
recommendations and guidelines identify and define the key elements that must be in place if the
approach is to prove safe, efficient, effective, equitable and sustainable. They cover the need for
consultation, situation analysis and national endorsement, and for an enabling regulatory
framework. They specify the quality assurance mechanisms, including standardized training,
supportive supervision, and certification and assessment, that will be important to ensure quality
of care. They cover the elements that will need to be considered for the purpose of ensuring
adequate resources for implementation and offer advice on the organization of clinical care
services under a task shifting approach.
Task shifting is already being implemented as a pragmatic response to health workforce shortages
to various degrees in a number of countries, and there is extensive evidence in the literature that
some forms of task shifting have been adopted informally in response to human resource needs
throughout history. These recommendations and guidelines aim to promote a formal framework
that can support task shifting as a national strategy for organizing the health workforce.
The experience of countries that are currently implementing task shifting specifically to increase
access to HIV services has been documented in a series of observational studies for the purpose
of informing these recommendations and guidelines. (These country studies are available as part
of the WHO-Commissioned Study on Task Shifting, which accompanies this document in
electronic Annex a). While this early available evidence of the success of task shifting for the
delivery of HIV services in a variety of settings is compelling, it is still preliminary. Implementation of
these recommendations and guidelines must therefore be accompanied by a rigorous evaluation
study that can assess various forms of task shifting.
The recommendations and guidelines on task shifting have been developed in the context of
efforts to rapidly increase access to HIV services in order to progress as far as possible towards
the goal of universal access to HIV services by 2010. However, the impact of task shifting would
not be restricted to HIV service delivery. The implications for other essential health services, and
the potential for wider health systems strengthening, are recognized throughout.