With nearly 60 countries, mostly in Africa, facing crippling health care shortages, and the global deficit of workers in the sector put at 4 million, the United Nations is pushing ahead with a so-called task shifting programme to quickly train primary care personnel.
At the first-ever international conference on task shifting this week in Addis Ababa, Ethiopia, co-sponsored by the UN World Health Organization (WHO), some 350 health ministers, public health leaders and HIV/AIDS experts are seeking to scale up access to HIV/AIDS treatment and, at the same time, expand the global health workforce by moving tasks to less specialized health workers to free up the time of doctors and nurses.
Task shifting maximizes the role of primary community-led health care, delivered closer to patients by an integrated team of health care professionals. “Doctors and nurses are essential but countries cannot afford to wait years while they complete their training,” WHO Assistant Director General Anders Nordström told the opening session.
Training a new community health worker takes between a few months and a year depending on the competencies required, a stark contrast to the three or four years required for a nurse to fully qualify. For a doctor it takes up to eight years.
“Task shifting not only addresses the two interlinked emergencies of the health worker crisis and the HIV/AIDS pandemic, but also offers long-term potential for strengthening health systems in a way that is consistent with the current renaissance in primary healthcare services,” Dr Nordström said.
The conference opened with the presentation of new WHO guidelines to assist countries to implement task shifting, developed in collaboration with the United
States President’s Emergency Plan for AIDS (PEPFAR), a conference co-sponsor, and UNAIDS, the Joint UN Programme on HIV/AIDS.
Part of a larger WHO-led initiative called “Treat, Train and Retain” to increase access to HIV/AIDS care, the guidelines are the result of 18 months of consultation involving 167 top public health and HIV/AIDS experts, and are based on evidence from experience and detailed evaluations in countries where task shifting is already being implemented.
“What is important is that these guidelines build on what is already in place with an aim to ensuring quality of care, better motivating and retaining health workers, and rapidly expanding care and treatment to the poorest in a safe, efficient and effective way,” UNAIDS Deputy Executive Director Michel Sidibe said.
Over the past few years, a number of countries, including Ethiopia, Haiti, Malawi and
Uganda, have made progress in task shifting. Ethiopia, for example, created new health worker cadres and accelerated pre-service training of a number of cadres.