Task Shifting
WHO UNESCO FIP Pharmacy Education Taskforce
Because of their knowledge of medicines and clinical therapeutics, pharmacists are suitably placed for task shifting in health care and could be further trained to undertake functions such as clinical management and laboratory diagnostics. Indeed, pharmacists have been shown to be willing, competent, and cost-effective providers of what the professional literature calls pharmaceutical care interventions; however, internationally, there is an underuse of pharmacists for patient care and public health efforts. [from abstract]
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Task-Shifting HIV Counselling and Testing Services in Zambia: the Role of Lay Counsellors
The Zambia Prevention, Care and Treatment Partnership began training and placing community volunteers as lay counsellors in order to complement the efforts of the health care workers in providing HIV counselling and testing services. These volunteers are trained using the standard national counselling and testing curriculum. This study was conducted to review the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services. [from abstract]
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Nurse-Driven, Community-Supported HIV/AIDS Treatment at the Primary Health Care Level in Rural Lesotho
A joint pilot program was launched at the primary health care level in Lesotho through which nurses were trained and empowered to assume high levels of clinical responsibility for HIV care, including ART. This nurse-driven, community-supported model of care has proven to be successful in delivering quality HIV/AIDS and TB services integrated into existing primary health care structures for a population living in remote, rural areas. [from summary]
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Use of Task-Shifting to Rapidly Scale-Up HIV Treatment Services: Experiences from Lusaka, Zambia
This report describes field experiences with task shifting in Lusaka, Zambia, where a large public-sector ART program has enrolled over 71,000 HIV-infected adults and children across 19 program sites. It advocates a comprehensive, three-pronged approach to task-shifting that comprises training, on-site clinical mentoring, and continuous quality assurance. A structured approach is important so that clinical care is not compromised when clinical duties are initially shifted to less specialized health professionals. [from introduction]
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Quest for Quality: Interventions to Improve Human Resources for Health among Faith-Based Organizations
Traditionally, faith-based health organisations have been important health care providers in many remote and other under-serviced areas. Currently, these facilities bear the brunt of the competition for scarce human resources. It is important for faith-based organisations to learn from recent experiences and from the creative ways in which colleagues seek to retain their health workers and improve quality of human resource management.
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Doctor Displacement: a Political Agenda or Health Care Imperative?
In the face of medical workforce shortages, governments are looking to displace doctors with alternative health care providers like nurse practitioners, physician assistants, and other health professionals such as psychologists and pharmacists to relieve bottlenecks in health care delivery. Displacing doctors in this way, or role or task substitution as it is also termed, has been actively pursued in the United Kingdom and United States. How should the medical profession react to these developments? [from author]
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Task Shifting: Successes from Mozambique and Rwanda
Non-physician clinicians and nurses can take over many of the tasks in providing HIV care and treatment (including ART) in some resource-limited settings
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Task Shifting
This article defines the concept of task shifting, outlines the World Health Organization’s “Treat, Train, Retain’s” recommendations and guidelines on task shifting, gives case study examples of how task shifting can be used, defines the remaining barriers and suggests the conditions necessary for the success of task shifting.
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Task Shifting in Health Care in Resource-Poor Countries
There is good evidence and compelling logic to support the principle of task shifting
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Fewer Doctors and More Community Involvement to Scale Up Antiretroviral Treatment
The researchers conclude that given the HRH crisis, ART delivery models requiring much less doctor time need to be developed. Overall, there is a need to shift tasks from medical doctors to nurses and from nurses to community health workers. In particular, the patients themselves need to play an important role in the delivery of ART. The outcomes of the various scenarios are predicted. [from author]
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Task Shifting: Considering Legal and Regulatory Barriers
There is a gross shortage of nurses, yet there is a need to provide quality care and defend patient care. Widening scope of practice is not new to all categories of nurses and given the Occupational Specific Dispensation for nurses there is a need to critically engage with these issues.
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Task Shifting for Antiretroviral Treatment Delivery in Sub-Saharan Africa: Not a Panacea
Task shifting should not be viewed as a panacea for the human resources challenges facing sub-Saharan Africa. Rather, it must be part of an overall strategy that includes measures to increase, retain, and sustain health staff. [from author]
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Intermittent Preventive Treatment of Malaria in Pregnancy: a New Delivery System and Its Effect on Maternal Health and Pregnancy Outcomes in Uganda
The objective of this study was to assess whether traditional birth attendants, drug-shop vendors, community reproductive-health workers, or adolescent peer mobilizers could administer intermittent preventive treatment (IPTp) for malaria with sulfadoxine-pyrimethamine to pregnant women. The study concludes that the use of the guideline with adequate training significantly improved correctness of malaria treatment with chloroquine at home. Adoption of this mode of intervention is recommended to improve compliance with drug use at home. The applicability for deploying artemisinin-based combination therapy at the community level needs to be investigated.
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Joint Health Professions Statement on Task Shifting
This statement outlines guiding principles to ensure task shifting is effective.
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Task Shifting May Prove Key to Tackling Infectious Diseases
Task shifting, a process whereby medical tasks are delegated to less specialized health-care workers, provides one mechanism to address some of the shortfalls of many health care systems. This article advocates for increased task shifting in health care systems, especially in the developing world. [adapted from author]
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Task Shifting: Rational Redistribution of Tasks among Health Workforce Teams
Reorganization and decentralization of health services according to a task shifting approach can help to address the current shortages of health workers. This document provides background on task-shifting and twenty-two guidelines for countries that are considering adopting or extending a task-shifting approach to health workforce teams. [from introduction]
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Task Shifting to Tackle Health Worker Shortages
The shortage of well-trained health workers is global, but low- and middle-income countries where HIV and AIDS are taking the greatest toll feel the crisis most acutely. This report provides examples and statistics about the potential for task shifting to help with the problem of health worker shortages. [adapted from author]
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Major Surgery Delegation to Mid-Level Health Practitioners in Mozambique: Health Professionals' Perceptions
This study examines the opinions of health professionals about the capacity and performance of the ‘tecnico de cirurgia’, a surgically trained assistant medical officer in the Mozambican health system. Particular attention is paid to the views of medical doctors and maternal and child health nurses. [from abstract]
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Safety and Feasibility of Community-Based Distribution of Depo Provera in Nakasongola, Uganda
In both Asia and Latin America, community-based health workers have been trained in safe injection techniques and routinely provide injectable contraception. However, the African continent still resists this service delivery mechanism with the rationale that it is unsafe for clients to receive injections from paramedical personnel. This argument is weakening, however, as non-reusable syringes become the norm and with the recent development of a checklist, based on the latest WHO Medical Eligibility Criteria, for safe provision of DMPA by community-based agents. Has the time come for community-based provision of DMPA in Africa?
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Impact of Home-Based Management of Malaria on Health Outcomes in Africa: a Systematic Review of the Evidence
Home-based management of malaria (HMM) is promoted as a major strategy to improve prompt delivery of effective malaria treatment in Africa. The published literature was searched for studies that evaluated the health impact of community- and home-based treatment for malaria in Africa. [from abstract]
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Community Workers Key to Improving Africa's Primary Care
In parts of rural Africa, where conflict and neglect have destroyed any remnants of a functioning health system, there is one long-running public-health programme that is not only surviving but thriving—by capitalising on communities’ desires to help themselves. [author’s description]
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Expansion of the Role of Nurse Auxiliaries in the Delivery of Reproductive Health Services in Honduras
The nurse auxiliaries who work at the rural health centers (CESARs) of the Honduran Ministry of Health (MOH) are frequently the only source of reproductive health services in the communities they serve. In order to increase access to long-term family planning methods, the MOH and the Population Council’s INOPAL III Project conducted an operations research study from 1997 to 1998 to see if nurse auxiliaries could provide good quality IUD, Depo-Provera and vaginal cytology services without health risks for their clients. The study concluded that auxiliaries could provide these services and that, in addition, the cost-effectiveness of the strategy was appropriate.
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Using Lay Counselors to Promote Community-Based Voluntary Counseling and HIV Testing in Rural Northern Ghana: a Baseline Survey on Community Acceptance and Stigma
Access to voluntary counseling and HIV testing (VCT) remains limited in most parts of Ghana with rural populations being the least served. Services remain facility-based and employ the use of an ever-dwindling number of health workers as counsellors. This study assessed approval for the use of lay counselors to promote community-based voluntary counseling and testing for HIV and the extent of HIV/AIDS-related stigma in the Kassena-Nankana district of rural northern Ghana. [from abstract]
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People First: African Solutions to the Health Worker Crisis
The health worker crisis is particularly acute in rural and hard to reach areas, where 80% of the population in Africa live. The resultant low capacity at the peripheral level of the health system is a crucial barrier to good health. AMREF believes that developing capable, motivated and supported health workers at all levels of the health system is essential in ensuring the delivery of accessible and effective health care across Africa… This briefing draws on AMREF’s experience to look at three key issues: the importance of appropriate training, task-shifting to lower cadres of worker, and training and supporting community health workers (CHW) in order to bring health care closer to communities.
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Private Sector Drug Retailers and Malaria Control in Kenya
Training private drug retailers can improve early treatment of malaria at home. As well as giving important health benefits, improvements could support over-stretched public health resources, reduce household economic costs and potentially play a role in reducing the rate of development of drug resistance for OTC anti-malarial medications. [author’s description]
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Bridging the Health Gap in Uganda: the Surgical Role of the Clinical Officer
A scarcity of trained medical personnel impedes Uganda’s ability to deliver healthcare effectively. The role of the Clinical Officer (CO) was established to assist the provision of primary healthcare to rural communities. The primary aim of this study was to explore the role that the CO performs in delivery of primary and secondary healthcare in Uganda. A secondary aim was to determine the resources and facilities that are available to COs in order to carry out these duties. A further aim was to determine the confidence of COs at performing surgical and obstetric procedures. [from introducti
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Achieving Child Survival Goals: Potential Contribution of Community Health Workers
This article discusses the potential contribution of community health workers to child survival rates. Several trials show substantial reductions in child mortality, particularly through case management of ill children by these types of community interventions. However, community health workers require focussed tasks, adequate remuneration, training, supervision, and the active involvement of the communities in which they work. This article discusses the need for evaluation of programmes for community health workers. [from summary]
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Training Shopkeepers to Improve Malaria Home Management in Rural Kenya
This article discusses the cost-effectiveness of a recent programme that involved training shopkeepers and community mobilisation for treating childhood fevers in the rural Kilifi District in Kenya. The programme offered workshops for shopkeepers on appropriate treatment for malaria in young children and also ran community information activities, with impact maintained through refresher training and monitoring. [author’s description]
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Uganda: Delivering Analgesia in Rural Africa: Opioid Availability and Nurse Prescribing
Hospice Africa Uganda introduced palliative medicine to Uganda in 1993 with enough funds to support a team of three clinicians for three months. Training in the medical and nursing schools was introduced in 1994. Since then, Uganda has achieved the three essential components of an effective public health strategy. It has also been the first country to have palliative care described as an essential clinical service and to change the law to allow nurses and clinical officers who complete special training in palliative medicine at Hospice Uganda to prescribe morphine. Palliative care is spreading throughout the districts of Uganda, ensuring that morphine will be available to everyone who needs it. [adapted from publisher’s description]
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Postoperative Outcome of Caesarean Sections and Other Major Emergency Obstetric Surgery by Clinical Officers and Medical Officers in Malawi
Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors. [abstract]
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