Harries AD: Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa

Médecins Sans Frontières, Medical Department, Brussels Operational Center, Rue de Gasperich, Luxembourg.
Transactions of the Royal Society of Tropical Medicine and Hygiene (Impact Factor: 1.84). 12/2008; 103(6):549-58. DOI: 10.1016/j.trstmh.2008.09.019
Source: PubMed


Sub-Saharan Africa is facing a crisis in human health resources due to a critical shortage of health workers. The shortage is compounded by a high burden of infectious diseases; emigration of trained professionals; difficult working conditions and low motivation. In particular, the burden of HIV/AIDS has led to the concept of task shifting being increasingly promoted as a way of rapidly expanding human resource capacity. This refers to the delegation of medical and health service responsibilities from higher to lower cadres of health staff, in some cases non-professionals. This paper, drawing on Médecins Sans Frontières' experience of scaling-up antiretroviral treatment in three sub-Saharan African countries (Malawi, South Africa and Lesotho) and supplemented by a review of the literature, highlights the main opportunities and challenges posed by task shifting and proposes specific actions to tackle the challenges. The opportunities include: increasing access to life-saving treatment; improving the workforce skills mix and health-system efficiency; enhancing the role of the community; cost advantages and reducing attrition and international 'brain drain'. The challenges include: maintaining quality and safety; addressing professional and institutional resistance; sustaining motivation and performance and preventing deaths of health workers from HIV/AIDS. Task shifting should not undermine the primary objective of improving patient benefits and public health outcomes.

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Available from: Mit Philips, Jul 28, 2014
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    • "There are, however , counter arguments that CHW treatment of pneumonia, if accompanied by proper supervision of CHWs, could actually decrease improper use of antibiotics (Marsh et al. 2008). Several authors (Zachariah et al. 2009; Fulton et al. 2011) have suggested that there is both professional and institutional resistance to shifting responsibilities for providing sensitive services involving powerful medical therapies to less skilled CHWs; however, the evidence base to support these assertions is not strong. "

    Health Policy and Planning 12/2015; 30(suppl 2):ii65-ii73. DOI:10.1093/heapol/czv094 · 3.47 Impact Factor
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    • "The World Health Organization has estimated that 57 countries face health worker shortages; 36 of these countries are in sub-Saharan Africa (World Health Organization, 2006). Task shifting is one of the responses to the human resource crisis and is defined as the shifting or delegation of health services tasks from high level cadres of workers to lower level cadres (Zachariah et al. 2009). Scaling up early interventions, using community health workers within existing health systems (Cooper et al. 2002, Klein & Rye, 2004, Walker et al. 2006), will allow us to identify the best ways of integrating interventions into existing health platforms, while helping to achieve the desired outcomes related to targets set for child survival and well-being (United Nations, 2013). "
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    • "Another challenge will be ensuring an adequate supply of trained health-care professionals to treat and monitor co-infection complexities and providing resources necessary to support and encourage adherence to treatment regimens (Eholie et al., 2012). These challenges emphasise the need to improve coordination efforts to successfully implement programmes, including task shifting and skill development opportunities for health-care workers (Zachariah et al., 2009). The challenges are all magnified in the setting of HIV/DR-TB co-infection due to the complexities in treatment, the added importance of adherence and the support required to ensure successful retention in care. "
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