IntraHealth Participates In First Global Conference On Task Shifting
Pape Gaye, IntraHealth International’s president and CEO, participated in the first international conference on task shifting, held in Addis Ababa, Ethiopia in January 2008. The conference launched the global recommendations and guidelines on task shifting developed by WHO in collaboration with UNAIDS and the US President’s Emergency Plan for AIDS Relief and resulted in a declaration, by all the countries present, to support the implementation of task shifting as one mechanism to scale up the delivery of antiretroviral therapy in countries with health workforce shortages.
“IntraHealth has been involved in task shifting for a long, long time,” says Gaye. “This organization has a history of working with all levels of cadres.” Gaye notes that one of IntraHealth’s first projects supported paramedical, auxiliary and community health workers, and that some of IntraHealth’s work was cited in the conference.
“We have a lot to bring to the table in terms of helping countries make policy decisions and adopt strategies for better preparing, deploying and retaining the health care workers,” Gaye emphasizes. “This whole discussion about task shifting reaffirmed the need for an organization like us to continue that focus.”
Task shifting is defined in the WHO guidelines as “the rational redistribution of clinical and other tasks among health care workers, according to their skills rather than their roles.” WHO guidelines propose four types of task shifting. In general terms, they are:
- Task shifting I: the extension of the scope of practice of non-physician clinicians to enable them to assume tasks previously undertaken by medical doctors and specialists. In Rwanda, for example, IntraHealth supports a program in which mobile district physicians mentor rural nurses to provide support to ART clients during their treatment regimens.
- Task shifting II: the extension of scope of practice of nurses and midwives to assume tasks previously undertaken by non-physician clinicians and doctors. In Kenya, for example, IntraHealth focused on shifting postabortion care services from hospitals to private-sector nurse-midwives.
- Task shifting III: the extension of scope of practice of community health workers to assume tasks of nurses, midwives, non-physician clinicians and medical doctors. In Mali, IntraHealth is demonstrating that matrones can perform active management of the third stage of labor to prevent postpartum hemorrhage; in Ethiopia, IntraHealth is working to provide home-based prevention of mother-to-child transmission of HIV services through health extension workers.
- Task Shifting IV: people living with AIDS assuming tasks related to their own care previously undertaken by health workers.
Gaye recommends tailoring training methodologies to prepare health workers. A cookie-cutter approach will not work well because of the many potentially different types of workers.
Gaye also notes that task shifting is just one of the options among many for health workforce strengthening. “It is a strategy, but it is not the answer to everything,” he cautions.
Gaye emphasizes that task shifting should be seen in the context of emergency and crisis situations. “We need to have a two-pronged strategy: find some immediate solutions—task shifting could be one of them—for dealing with the crisis but then continue to build strong nursing schools, strong medical schools, even if we have to think of doing it slightly differently.” Through its leadership of the USAID-funded global Capacity Project and other programs, IntraHealth endorses continued support to countries to strengthen their health systems, including better planning, development and retention of health care workers.
For more information on task shifting, see:
To view the complete Addis Ababa declaration, click here. For more information on the conference, please click here.