title: Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa.
abstract: Sub-Saharan Africa is facing a crisis in human health resources due to a critical shortage of health workers. The shortage is compounded by a high burden of infectious diseases; emigration of trained professionals; difficult working conditions and low motivation. In particular, the burden of HIV/AIDS has led to the concept of task shifting being increasingly promoted as a way of rapidly expanding human resource capacity. This refers to the delegation of medical and health service responsibilities from higher to lower cadres of health staff, in some cases non-professionals. This paper, drawing on Médecins Sans Frontières' experience of scaling-up antiretroviral treatment in three sub-Saharan African countries (Malawi, South Africa and Lesotho) and supplemented by a review of the literature, highlights the main opportunities and challenges posed by task shifting and proposes specific actions to tackle the challenges. The opportunities include: increasing access to life-saving treatment; improving the workforce skills mix and health-system efficiency; enhancing the role of the community; cost advantages and reducing attrition and international 'brain drain'. The challenges include: maintaining quality and safety; addressing professional and institutional resistance; sustaining motivation and performance and preventing deaths of health workers from HIV/AIDS. Task shifting should not undermine the primary objective of improving patient benefits and public health outcomes.
authors.affiliation: Médecins Sans Frontières, Medical Department, Brussels Operational Center, Rue de Gasperich, Luxembourg. zachariah@internet.lu
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
authors.forename: N
authors.initials: N
authors.lastname: Ford
authors.forename: M
authors.initials: M
authors.lastname: Philips
authors.forename: S
authors.initials: S
authors.lastname: Lynch
authors.forename: M
authors.initials: M
authors.lastname: Massaquoi
authors.forename: V
authors.initials: V
authors.lastname: Janssens
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D001291:Attitude of Health Personnel; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000628:therapy*; D015497:HIV-1; D006295:Health Resources / Q000458:organization & administration*; D006801:Humans; D008297:Male; D020380:Needs Assessment / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*