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TITLE from VIEW and SLIDE MASTER | 27 July 20061 |
Task shifting: rational redistribution of tasks among health workforce teams
Annette Mwansa NkowaneHRH Department
Health Systems and ServicesWorld Health Organization
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TITLE from VIEW and SLIDE MASTER | 27 July 20062 |
200
1000
800
600
400
(den
sit
y
HW
/10
0,0
00
p)
55
Doctors/100,000pDoctors/100,000p
691137
Nurses/100,000pNurses/100,000p
25
388
1
Malawi Malawi BotswanaBotswana S. Africa S. Africa
29
256
UKUK
937
Number of doctors and nurses in selected countries
ZambiZambia a
241
WHR, 2006
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TITLE from VIEW and SLIDE MASTER | 27 July 20063 |
20%20%
40%40%
60%60%
23%23%
38%38%
42%42%
DoctorsDoctors NursesNurses OthersOthers
% in
rur
al lo
calit
ies
Urban vs. rural distribution of health workers
WHR, 2006
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TITLE from VIEW and SLIDE MASTER | 27 July 20064 |
Number of community health workers per 1000 population
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TITLE from VIEW and SLIDE MASTER | 27 July 20065 |
First contact with health system for people living with HIV
39%24%
16% 6%15% CHWs
Doctors
SocialWorkersNurses
Others
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TITLE from VIEW and SLIDE MASTER | 27 July 20066 |
Task Shifting
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TITLE from VIEW and SLIDE MASTER | 27 July 20067 |
Task Shifting
The key questions:
– Impact on coverage?
– Impact on quality of services?
– Cost-effective?
– Acceptable by service users?
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TITLE from VIEW and SLIDE MASTER | 27 July 20068 |
1 ,000,000
2005 2006 2007
500,000
Num
ber
of p
eopl
e te
sted
for
HIV
500 000500 000
1 600 0001 600 000
436 854436 854
Task shifting and HIV T&C coverage in Ethiopia
CHWs performing HIV T&C
1,500,000
MOH Ethiopia, 2007
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TITLE from VIEW and SLIDE MASTER | 27 July 20069 |
ART delivery by cadre in the US
Performance is similar or higher for PA compared to
physicians.
CadreAdjusted rate (95% CI)
P-value
ID physician0.84 (0.81-0.86)0.29
GP HIV expert0.83 (0.80-0.85)0.51
GP non HIV exp
0.75 (0.65-0.80)0.04
Physician Asst
0.82 (0.78-0.85)Ref
Wilson et al, Annals of Internal Medicine, 2005
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TITLE from VIEW and SLIDE MASTER | 27 July 200610 |
TB treatment in hospitals and communities
WHO, 2003
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TITLE from VIEW and SLIDE MASTER | 27 July 200611 |
Cost-effectiveness of task shifting in TB care
WHO, 2003
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TITLE from VIEW and SLIDE MASTER | 27 July 200612 |
How confident and satisfied are you with the services provided by CHWs?
67%
28%
3%
Extremely satisfied Very satisfied
Not satisfiedFairly satisfied
3%
WHO commissioned study on Task Shifting, Central Plateau, Haiti
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TITLE from VIEW and SLIDE MASTER | 27 July 200613 |
The essential requirements for task shifting
– Quality assurance
– Regulatory framework
– Sustainability
– Involvement of service users
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TITLE from VIEW and SLIDE MASTER | 27 July 200614 |
Thank you