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

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

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

TITLE from VIEW and SLIDE MASTER | 27 July 20064 |

Number of community health workers per 1000 population

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

TITLE from VIEW and SLIDE MASTER | 27 July 20066 |

Task Shifting

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?

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

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

TITLE from VIEW and SLIDE MASTER | 27 July 200610 |

TB treatment in hospitals and communities

WHO, 2003

TITLE from VIEW and SLIDE MASTER | 27 July 200611 |

Cost-effectiveness of task shifting in TB care

WHO, 2003

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

TITLE from VIEW and SLIDE MASTER | 27 July 200613 |

The essential requirements for task shifting

– Quality assurance

– Regulatory framework

– Sustainability

– Involvement of service users

TITLE from VIEW and SLIDE MASTER | 27 July 200614 |

Thank you