Abstract
The World Health Organization advocates task-shifting, the process of delegating clinical care functions from more specialized to less specialized health workers, as a strategy to achieve the United Nations Millennium Development Goals. However, there is a dearth of literature describing task shifting in sub-Saharan Africa, where services for antiretroviral therapy (ART) have scaled up rapidly in the face of generalized human resource crises. As part of ART services expansion in Lusaka, Zambia, we implemented a comprehensive task-shifting program among existing health providers and community-based workers. Training begins with didactic sessions targeting specialized skill sets. This is followed by an intensive period of practical mentorship, where providers are paired with trainers before working independently. We provide on-going quality assessment using key indicators of clinical care quality at each site. Program performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. From 2005 to 2007, we trained 516 health providers in adult HIV treatment; 270 in pediatric HIV treatment; 341 in adherence counseling; 91 in a specialty nurse "triage" course, and 93 in an intensive clinical mentorship program. On-going quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. Our task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful, long-term solutions to the human resource crisis are also urgently needed to expand the number of providers and to slow staff migration out of the region.
Highlights
Like many neighboring countries in sub-Saharan Africa, services for antiretroviral therapy (ART) in Zambia have expanded rapidly in recent years [1,2]
BMC Health Services Research 2009, 9:5 http://www.biomedcentral.com/1472-6963/9/5 fold increase in less than five years. This progress has been made in spite of significant shortages of health care workers
With as many as 330,000 Zambians still in urgent need of HIV treatment country-wide, and more becoming eligible each year, successful and continued expansion of ART services will largely depend on the ability to address the growing human resource crisis
Summary
Like many neighboring countries in sub-Saharan Africa, services for antiretroviral therapy (ART) in Zambia have expanded rapidly in recent years [1,2]. BMC Health Services Research 2009, 9:5 http://www.biomedcentral.com/1472-6963/9/5 fold increase in less than five years. This progress has been made in spite of significant shortages of health care workers. Staffing deficits over this period were estimated at over 70% for doctors, clinical officers, and nurses [3]. With as many as 330,000 Zambians still in urgent need of HIV treatment country-wide, and more becoming eligible each year, successful and continued expansion of ART services will largely depend on the ability to address the growing human resource crisis. "Task-shifting" is the process of delegating tasks from more specialized to less specialized health workers and has been proposed as one of several possible solutions to the dire human resource shortages facing the African health sector [4]
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