Abstract
BackgroundShortages of human resources for health (HRH) have severely hampered the rollout of antiretroviral therapy (ART) in sub-Saharan Africa. Current rollout models are hospital- and physician-intensive. Task shifting, or delegating tasks performed by physicians to staff with lower-level qualifications, is considered a means of expanding rollout in resource-poor or HRH-limited settings.MethodsWe conducted a systematic literature review. Medline, the Cochrane library, the Social Science Citation Index, and the South African National Health Research Database were searched with the following terms: task shift*, balance of care, non-physician clinicians, substitute health care worker, community care givers, primary healthcare teams, cadres, and nurs* HIV. We mined bibliographies and corresponded with authors for further results. Grey literature was searched online, and conference proceedings searched for abstracts.ResultsWe found 2960 articles, of which 84 were included in the core review. 51 reported outcomes, including research from 10 countries in sub-Saharan Africa. The most common intervention studied was the delegation of tasks (especially initiating and monitoring HAART) from doctors to nurses and other non-physician clinicians. Five studies showed increased access to HAART through expanded clinical capacity; two concluded task shifting is cost effective; 9 showed staff equal or better quality of care; studies on non-physician clinician agreement with physician decisions was mixed, with the majority showing good agreement.ConclusionsTask shifting is an effective strategy for addressing shortages of HRH in HIV treatment and care. Task shifting offers high-quality, cost-effective care to more patients than a physician-centered model. The main challenges to implementation include adequate and sustainable training, support and pay for staff in new roles, the integration of new members into healthcare teams, and the compliance of regulatory bodies. Task shifting should be considered for careful implementation where HRH shortages threaten rollout programmes.
Highlights
Sub-Saharan Africa suffers from the world's most pronounced crisis in human resources for health: 36 of the 57 countries that face health worker shortages are in Africa [1]
Much interest has recently been paid to how to streamline HIV care, both to offer high-quality care to patients and expand access to care. One response to this shortage has been the reassignment of clinical roles by shifting tasks to different cadres of health workers: nurses may become involved in prescribing drugs, lay counsellors involved in testing, new cadres may be introduced to perform specific tasks, and patients
Efficiency We found evidence that task shifting increases programme efficiency
Summary
Sub-Saharan Africa suffers from the world's most pronounced crisis in human resources for health: 36 of the 57 countries that face health worker shortages are in Africa [1]. These shortages intensify--and are intensified by--the HIV/AIDS pandemic. Much interest has recently been paid to how to streamline HIV care, both to offer high-quality care to patients and expand access to care One response to this shortage has been the reassignment of clinical roles by shifting tasks to different cadres of health workers: nurses may become involved in prescribing drugs, lay counsellors involved in testing, new cadres may be introduced to perform specific tasks, and patients. Delegating tasks performed by physicians to staff with lower-level qualifications, is considered a means of expanding rollout in resource-poor or HRH-limited settings
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