world health organization. task shifting for integrated and decentralized hiv treatment eyerusalem...
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World Health Organization
Task shifting for integrated and decentralized HIV treatment
Eyerusalem Negussie, Margaret Streeten, Brian Pazvakavambwa, Amitabh Suthar, Frank Lule, Andrew Ball
WHO – Task Shifting
● Growing number of people require chronic care- high burden settings
● The need for comprehensive care, and ensure continuity of care
● Role of patient education, community involvement and broader support on access, linkage, retention and adherence to treatment
● Limited human resource in most settings
Human resource: availability, mix, skill
Growing number of people require chronic care
WHO – Task shifting
WHO, UNAIDS, UNICEF. 2011. Universal access report
• Significant overlap with high HIV burden
WHO. 2006. Global report
• Health workers tend to concentrate in urban settings
WHO. 2006. Global report
Regulatory framework
Quality assurance, ongoing learning, supportive supervision, professional development
Sustainability
Essential for effective task shifting
WHO – Task shifting
WHO – Task Shifting
Quick assessment: 22 countries national programme managers • 1 country has regulatory framework for non-
medical doctors to provide ART;
1. Task shifting: Rational distribution of tasks among health workers to provide chronic care
WHO – Task shifting
PhysiciansPediatriciansPhysicians
Pediatricians
Medical officers,
GPs*
Medical officers,
GPs*
Clinical officers*Clinical officers*
Midwives,MCH
nurses
Midwives,MCH
nursesTB clinicTB clinic
PLHIV(self-management)
PLHIV(self-management)
Nursing assistants,counselors, "lay" counselors:
PLHIV on clinical team
Nursing assistants,counselors, "lay" counselors:
PLHIV on clinical team
CHW, other community-based practitioners
Community volunteers(PLHIV and others)
CHW, other community-based practitioners
Community volunteers(PLHIV and others)
Family caregiversFamily caregivers
NursesNurses
* "District clinicians" providing outpatient and inpatient care at district hospital, depending on country
Decentralization and task shifting
Clinical teams led by anurse or clinical officer
Primary care level Close to home
Community-based support
District hospital
Central/RegionalHospitals
Community workers- testing, counselling, patient education, triage and weight, retrieve pt chart, screening for TB, provision of cotrimoxazole prophylaxis, ARV pickup spots, support
WHO – Task Shifting
WHO 2013 consolidated guideline • Evidence review on task shifting in HIV care and
treatment – from physicians to non-physician health workers;– Across population group: infants, children,
adolescents and adults, pregnant and postpartum women,
– By different cadres of health workers– ART initiation, ART maintenance in stable patients, in
the management of certain conditions.
Acknowledgement
• National Programme managers of MoH and WHO staff- who facilitated the country survey.