Task shifting: the answer to the human resources crisis in Africa?

Abstract

Ever since the 2006 World Health Report advocated increased community participation and the systematic delegation of tasks to less-specialized cadres, there has been a great deal of debate about the expediency, efficacy and modalities of task shifting.The delegation of tasks from one cadre to another, previously often called substitution, is not a new concept. It has been used in many countries and for many decades, either as a response to emergency needs or as a method to provide adequate care at primary and secondary levels, especially in understaffed rural facilities, to enhance quality and reduce costs. However, rapidly increasing care needs generated by the HIV/AIDS epidemic and accelerating human resource crises in many African countries have given the concept and practice of task shifting new prominence and urgency. Furthermore, the question arises as to whether task shifting and increased community participation can be more than a short-term solution to address the HIV/AIDS crisis and can contribute to a revival of the primary health care approach as an answer to health systems crises.In this commentary we argue that, while task shifting holds great promise, any long-term success of task shifting hinges on serious political and financial commitments. We reason that it requires a comprehensive and integrated reconfiguration of health teams, changed scopes of practice and regulatory frameworks and enhanced training infrastructure, as well as availability of reliable medium- to long-term funding, with time frames of 20 to 30 years instead of three to five years. The concept and practice of community participation needs to be revisited.Most importantly, task shifting strategies require leadership from national governments to ensure an enabling regulatory framework; drive the implementation of relevant policies; guide and support training institutions and ensure adequate resources; and harness the support of the multiple stakeholders. With such leadership and a willingness to learn from those with relevant experience (for example, Brazil, Ethiopia, Malawi, Mozambique and Zambia), task shifting can indeed make a vital contribution to building sustainable, cost-effective and equitable health care systems. Without it, task shifting runs the risk of being yet another unsuccessful health sector reform initiative.

Task Shifting in Rural Tanzania: Characteristics and Quality Implications of Semi-Skilled Health Staff Serving in Lindi and Mtwara Regions

“…This calls for interim measures for improving work performance -including short-term training programmes. The impact of training in improving performance of semi-skilled staff has been demonstrated in Brazil, Zambia, Ethiopia, Malawi, and Mozambique [21,22].…”

Integrating Family Planning and HIV Services at the Community Level: Formative Assessment with Village Health Teams in Uganda

“…In light of the health workforce crisis, CHWs' responsibilities are being reconfigured toward an increasingly substantial role in service delivery in several settings 7,8 . Despite calls for task-shifting in both FP and HIV 6,9 , however, the scope of their involvement in integrated approaches has expanded slowly. Consequently, few studies have examined integrated service provision by CHWs.…”

Retention and Task Shifting in Human Resources for Health through Data Mining

“…The delegation of medical tasks from one cadre to another has been used for many decades to enhance quality and reduce costs, especially in understaffed rural areas (Lehmann et al, 2009). In Africa, non-physician clinicians have been trained to fill various roles.…”

“…Nurse-managed antiretroviral therapy (ART) for HIV infections was not inferior to doctor-managed ART in Africa: both treatment services had similar outcomes for viral suppression, adherence, toxicity and death (Sanne et al, 2010). Delegating tasks can improve the coverage and quality of and access to health services (Lehmann et al, 2009). Efforts at improving Africa's health systems can only succeed if the necessary socio-economic, educational, and technological infrastructure are in place (Olapade-Olaopa et al, 2017).…”

“…Since the 2006 World Health Report advocated increased community participation and the systematic delegation of tasks to less-specialized personnel, there have been many debates regarding the efficacy, modalities and expediency of task shifting (Lehmann, Van Damme, Barten, & Sanders, 2009). The opportunities from task shifting include increasing access to health care, expanding the workforce skills mix, improving health-system efficiency, enhancing the role of the community, and reducing costs, attrition and international 'brain drain'.…”