‘Re-Engineering the Workforce to Meet Service Needs’: Exploring ‘Task-Shifting’ in South Africa in the Context of Hiv/Aids and Antiretroviral Therapy

Abstract

This article explores the major trends in the South African health workforce in the context of HIV/ AIDS and analyses their potential impact on the professional work and status of nurses and doctors. The Human Resources for Health Strategy for the Health Sector 2012/13-2016/17 document, in addition to a wide range of secondary material, is used to depict the shifts that have taken place in the SA health workforce as a response to the unmet health needs and demands emanating from HIV/AIDS. Such a response is particularly challenging in the context of limited-resource settings and inadequate public healthcare services. Therefore, there has been a need to come up with inventive ideas to mobilise all available resources to curtail the spread of the epidemic as well as to cope with the provision of ART to large numbers of people as quickly as possible. Adopting a critical-analytical approach, this article draws attention to three such ideas: task-shifting, the training of new midlevel workers, and the use of members from the community in a variety of roles as 'community health workers'. Although these ideas are not new, they acquire acute poignancy in the context of HIV/AIDS in South Africa today. They also provide an interesting case study through which to interrogate arguments advanced in the sociology of the professions about 'medical dominance', 'occupational monopoly', 'laymanisation' and the potential challenge to medical authority and power that may have occurred alongside shifts in professional boundaries.

An evaluation of the adequacy of pharmaceutical services for the provision of antiretroviral treatment in primary health care clinics

“…The roll-out of the 2013 PMTCT guidelines requires nurses working in basic antenatal care to prescribe and dispense fixed-dose combination ART to all HIVpositive pregnant women. However, according to national requirements, ART should be dispensed under the direct supervision of a qualified pharmacist (Georgeu et al, 2012;Gilbert, 2013). The Pharmacy Council of South Africa (2011) clearly describes the scope of practice of pharmacy support staff such as pharmacist's assistants, pharmacy technical assistants and pharmacy technicians, yet the scope of practice of nurses trained in drug dispensing is not clearly outlined.…”

“…In addition, a meta-analysis by Emdin, Chong, and Millson (2013) showed that care provided by non-physicians may result in reduced loss to follow-up rates. Despite these encouraging outcomes, evidence for NIMART in Africa is still limited and possible barriers to implementation and its implications for the workforce need further investigation (Emdin et al, 2013;Gilbert, 2013;Georgeu et al, 2012). Resource disparities between clinics and local clinic factors may influence the long-term success and quality of a decentralised model of care through NIMART (Uebel, Guise, Georgeu, Colvin, & Lewin, 2013).…”

“…The shortage of pharmacists in the public health sector in South Africa has led to pharmacists' assistants and nurses taking on drug supply management and dispensing duties to support the ART roll-out (Foster & McIntyre, 2012). High-quality, effective health services depend on the timely employment of the right people with appropriate skills at the right time and place (Gilbert, 2013). Yet South Africa has a chronic shortage of trained health care workers, which is exacerbated by disparities between provinces and between the rural and urban sectors (Gilbert, 2013).…”

“…High-quality, effective health services depend on the timely employment of the right people with appropriate skills at the right time and place (Gilbert, 2013). Yet South Africa has a chronic shortage of trained health care workers, which is exacerbated by disparities between provinces and between the rural and urban sectors (Gilbert, 2013). Subsequently, strategies such as task shifting are welcomed as an alternative, innovative way to alleviate the burden of care in resource-constrained settings (Callaghan, Ford, & Schneider, 2010).…”

‘Pharmacists have been left out of the loop’: exploring the role of pharmacists in the management of HIV/AIDS in South Africa

“…The HIV/AIDS crisis in SA, which is associated with severe strains placed on the healthcare system and those who work within it, calls for a novel response that is challenging traditional understandings of the role of all health professionals. [12,13]…”