Task shifting of HIV management from doctors to nurses in Africa: Clinical outcomes and evidence on nurse self-efficacy and job satisfaction

Abstract

With 24% global disease burden and 3% global health workforce, the World Health Organization (WHO) designates the African region a critical workforce shortage area. Task shifting is a WHO-recommended strategy for countries with severe health worker shortages. It involves redistribution of healthcare tasks to make efficient use of available workers. Severe physician shortages, increasing HIV disease burden, and the need for improved access to antiretroviral treatment (ART) posed serious challenges for Africa. Shifting ART management from physicians to nurses was adopted by many countries to increase access to treatment. Growing evidence from Africa supports this model of care but little is known about its impact on African nurses. A PubMed literature search was conducted for most recent task-shifting studies in Africa between January 2009 and August 2012. Thirty-four studies were identified but 11 met criteria for "task shifting from physicians to nurses in HIV settings." The methodologies and findings related to patient outcome, nurses' perceived self-efficacy, and job satisfaction were summarized. Patient outcomes were measured in 10 of the studies and all demonstrated comparable results. Seven of eight studies showed no difference in mortality while five found better retention and lower client loss to follow-up in nurse-managed groups. Four studies showed that nurses built on existing nursing and HIV knowledge; improved HIV and other disease management skills; and had increased comfort levels with using treatment guidelines. Results of job satisfaction from three studies showed that nurses expressed "feelings of emotional rewards, accomplishment, prestige, and improved morale." In six studies, nurse-managed care was acceptable to patients in five studies, nurses in two studies, and majority of physicians and program managers in one study. Nurse-managed care had comparable outcomes and retained more patients but only two studies "directly" assessed nurses' perceptions. Research exploring nurses' response, self-efficacy, and job satisfaction are critically to sustainability.

Establishing a health information workforce: innovation for low- and middle-income countries

“…Twelve percent of the district M&E Officer posts were vacated during the first year, with low job satisfaction as the main factor. This is in-line with findings from a recent literature review of studies in Africa investigating the shifting of tasks from physicians to nurses that found that job satisfaction was closely related to staff retention and important for sustainability [23]. Given that the capacity development activities for this new cadre were based on the incremental building of skills, retaining staff was especially important.…”

Integration of mental health into primary healthcare in low-income countries: Avoiding medicalization

“…Potential benefi ts of task shifting include increased coverage, more efficient use of available healthcare staff and utilization of local staff who are familiar with locally used expressions and presentations of mental distress, with a reduction of stigma (Kagee et al, 2013;van Ginneken et al, 2013). Barriers to a task sharing approach include the signifi cant rates of staff turnover in many primary healthcare settings, the requirement of substantial training and supervision, and the risk of ' task dumping ' (overloading primary health workers with tasks they cannot reasonably perform well) Iwu & Holzemer, 2014). There is now broad international consensus around the critical need to train non-specialist health workers, in low-and middle-income settings, in diagnosing and managing mental disorders .…”

Patient and Provider Satisfaction With a Comprehensive Strategy to Improve Prevention of Mother-to-Child HIV Transmission Services in Rural Nigeria

“…In Thailand, HIV-infected patients exposed to a nurse-led primary care service reported greater satisfaction with services than their counterparts who continued to be seen by physicians. 22 Iwu and Holzemer 23 reviewed studies of physician-to-nurse task shifting in HIV settings in Sub-Saharan Africa; they reported increased levels of job satisfaction, as indicated by feelings of stature, achievement, and morale among nurses in 3 studies. In Malawi, patients rated HIV prevention services more positively after the hospital workers (including physicians) received training in delivering peer-led HIV prevention interventions.…”

“…17,19–21 Fewer studies have focused on the impact of task shifting on patient satisfaction with clinical services and the satisfaction of the lower-cadre workers with their new positions. 13,22,23 …”