Task shifting of HIV antiretroviral treatment (ART) delivery in sub-Saharan Africa – ie, delegation of parts of that strategy to nurses or lay workers – is welcome, but cannot be considered in isolation. In must be used in conjunction with other measures to expand the health workforce to make further ART roll out possible. These are the conclusions of authors of a Viewpoint in this week’s Human Resources for Health Special Issue of The Lancet.
Dr Mit Philips, Médecins Sans Frontières, Brussels, Belgium, and colleagues, say that task-shifting is a concept already familiar in many high-income countries, eg, nurse practitioners in the USA and nurse clinicians in Sweden; and the authors look at experience and prospects for delegation of ART care to so-called ‘lower cadre’ or ‘less-qualified’ workers in sub-Saharan Africa. The lack of qualified health workers in sub-Saharan Africa is recognised as a crisis in the international community, and the advent of HIV ART and the urgent need to get it to thousands of people in Africa has further exposed the existing gaps in health staff in public health care services.
Within WHO’s Treat Train, Retain (TTR) initiative, task shifting is receiving increasing attention as a measure to allow ART roll-out in countries with shortages of human resources; this drive was further boosted by launch of WHO policy guidelines in January this year. Countries such as Uganda, Ethiopia and Malawi are considering using the strategy.
The authors say that if task-shifting is adopted it is important that quality of care is maintained, and that use of lower cadres and communities can increase coverage and improve overall outcomes. But supervision and support to these lower cadre workers is essential; moreover they must not have their roles complicated by too many different tasks and need adequate pay so they sustain their output for longer periods and without the need to make patients pay for their care.
They stress that task shifting does not equal a need for fewer staff. It can help relieve dependence on specific qualified cadres (eg, medical doctors) to roll out ART. The authors say: “The strategy thus promotes a more strategic mix of skills. However, task shifting alone, will not fill the gaps in the many peripheral health facilities in sub-Saharan Africa that do not presently meet the minimum requirements of qualified staff.” The Viewpoint also highlights that some sub-Saharan African countries actually have qualified people in their workforces, but there are difficulties recruiting and retaining such staff due to limits on recruitment and salary in the public sector.
The authors conclude: “Task shifting is a welcome strategy but cannot be considered in isolation: it needs to be part of an overall strategy in trying to address the human resources challenges facing countries with a high prevalence of HIV….Exceptional measures are needed to address the current human resource crisis and these go beyond task shifting alone.”
Dr Mit Philips, Médecins Sans Frontières, Brussels, Belgium T) +32 494 40 78 65 E) Mit.PHILIPS@brussels.msf.org
PDF OF VIEWPOINT: http://multimedia.thelancet.com/pdf/press/Taskshifting.pdf
Journal
The Lancet