Task Shifting for Scale-up of HIV Care: Evaluation of Nurse-Centered Antiretroviral Treatment at Rural Health Centers in Rwanda

Abstract

Fabienne Shumbusho and colleagues evaluate a task-shifting model of nurse-centered antiretroviral treatment prescribing in rural primary health centers in Rwanda and find that nurses can effectively and safely prescribe ART when given adequate training, mentoring, and support.

Determinants of personal resilience in the workplace: nurse prescribing in an African work context

“…HRD provides highly specialised nursing education, extensive clinical experience beyond basic nursing training and a well-resourced healthcare infrastructure as seen in advanced economies such as USA, Sweden, Australia, New Zealand, Canada and the UK, (Ross and Kettles 2012;Gallagher et al 2006;Groves 2012). This expertise required for 6 nurse prescribing in advanced economies is largely inadequate in developing countries such as those in Africa (Kinfu et al 2009) where nurse prescribing is seen as an unavoidable solution to high disease incidence and shortage of medical doctors (Shumbusho et al 2009). …”

“…Professionals responsible for HRD need research that will help them better understand how to motivate and retain employees (Alkire and Avey 2013;Carnevale and Smith 2013) in adverse and risky work contexts (CIPD 2011). Nurse prescribing in African countries is risky because of the potential negative consequences, such as faulty diagnosis/prescriptions that are damaging to patients and/or patients feeling discouraged to consult nurses given their knowledge that prescribing is the role of medical doctors (Shumbusho et al 2009). This makes nurse prescribing a suitable work context for analysing how nurses respond to such work context challenges and how their responses can be aligned with HRD practice (e.g.…”

“…Dealing with constraints includes negotiating competency, professionalism and risks, which is crucial to the effectiveness of nurses (Cant, Watts, and Ruston 2011) At the organisational level, HRD plans and procedures affect employee resilience. An organisation's reward system has been shown to affect the mental and physical health of nurses, with high wages and performance incentives seen as motivating employees to provide high quality service under pressure and vice versa (Donovan 2013;Shumbusho et al 2009). …”

“…Nurse prescribing, a practice in which nurses 3 diagnose and prescribe (Latter 2008) is widely accepted as a solution to the severe shortage of doctors in developing countries despite nurses not having an equivalent training as doctors to do so (Stark, Nair, and Omi 1999;Miles, Seitio, and McGilvery 2006;Shumbusho et al 2009). In addition to the challenges of taking on professional roles that are traditional allotted to doctors, nurse prescribing in developing countries take place in a risky and vulnerable work environment due to poor working conditions, staff shortages, limited training, professional/ethical dilemmas and high workload (Kinfu et al 2009;Miles, Seitio, and McGilvery 2006).…”

Why US Health Care Should Think Globally

“…Successful health care systems in low-resource settings are designed to target and serve the poor in ways that are contextually appropriate-addressing social, cultural, and economic barriers to care-and make efficient use of limited resources. Among numerous public health innovations, Rwanda has tested performance-based financing to improve the use and quality of child and maternal health services [8]; piloted antiretroviral treatment led by nurses rather than physicians [9]; and deployed various local interventions to increase health insurance coverage, even in poor communities, and so reduce out-of-pocket expenditures [10]. As soaring costs increasingly threaten to make health care unaffordable, causing the greatest harm to the disenfranchised, the United States should look to systems that serve difficult-to-reach populations and deliver quality care-and do so efficiently.…”