Transcript Document

Human Resources for Health
Elements for Successful and Sustainable
Task Shifting
Rebecca Kohler
IntraHealth International
Chapel Hill, North Carolina
March 11, 2010
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Health Workers Save Lives!
Source: World Health Organization (WHO). Working together for health. World Health Report 2006
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Entry points to increase equitable availability of
skilled health workers
Shift Tasks
(inc. volunteers)
Increase Entrants
Reduce Losses
Improve Distribution
Improve Productivity
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Task Shifting is defined by WHO as the rational redistribution of
clinical and other tasks, among health care workers, according to their
skills, rather than their roles.
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Task Shifting: Four Levels
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Task Shifting Levels
From
To
Illustrative
Services
Specialist Doctors
PHC Doctors
EmoC, Anesethia
Doctors
Mid-level providers
EmoC
Physicians
Nurses, Midwives
ART, MVA, IUD
Level 3
Nurses, Midwives
Paraprofessionals,
Assistant nurses,
midwives
SBA, IUD
Level 4
Paraprofessionals
Community-based
workers
DMPA, ANC,
newborn care,
Level 1
Level 2
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Recipe for Success in Task Shifting
• Supportive policy and regulatory framework
• An efficient, competency-based training strategy
• Responsive logistics system
• Adequate supervisory system
• Appropriate financial and non-financial motivation
• Readiness at the community and client level
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Context-specific example:
Level 1: EmoC by mid-level providers
• Quality of care comparable (wound rupture, stillbirth, early
neonatal death, maternal death or prolonged hospital stay)
• Mid-level providers more likely to stay in remote locations
• Costs per surgery significantly less among mid-level
providers versus physicians
• Challenges include supervision, on-going education,
career path, remuneration
Sources: Kruk, et al, BJOG, March 2007; Pereia, et al, BJOG, Sept 2007; Pereria, et al,
BJOG June 1996.
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Context-specific example:
Level 3: Assistant nurse-midwives, paramedics as SBA
• Services reach to the peripheral level
• Cadres are able to perform skills to standard (using
performance checklists)
• Increase in appropriate referrals (complicated cases)
• Community and client acceptance high
• Challenges: supervision, transport, 24/7 access, supply
chain management
Sources: Technical Report, USAID/NSDP/Pathfinder, 2007; USAID/Vistaar
Project MIS Data
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Context-specific example:
Level 1: Community Health Workers offering DMPA
• Offered in more than dozen countries, including
Afghanistan, Bangladesh, Nepal
• With appropriate training, can offer DMPA safely and
effectively
• Continuation rates comparable with those of facilitybased clients
• High client satisfaction
Sources: Community-based health workers can safely and effectively
administer injectable contraceptives, FHI, 2009
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Future Considerations
• How we define the limits of care
• Competency based training and linkages between preand in-service
• Recognition, reward, remuneration
• Understanding cost-effectiveness of different models
• Engagement of professional associations and regulatory
bodies
• Ensuring community “acceptance” of new cadres and
roles
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Capacity Plus Project (2010-2014)
For more HRH information, tools and
approaches visit :
www.HRHresourcecenter.org