title: Involving new actors to achieve ART scaling-up: difficulties in an HIV/AIDS counselling and testing centre in Cameroon.
abstract: BACKGROUND
  The high HIV/AIDS-related mortality among young adults is devastating countries in sub-Saharan Africa. The implementing capacity of the health systems is the main limiting factor of antiretroviral treatment (ART) scaling-up;(1) this capacity depends mainly on the health workforce. Tackling the issue of human resources for health is thus of paramount importance to achieve universal access to ART and for the survival of health systems in time of AIDS. To support such a process, the World Health Organization stresses the importance of task shifting(2) from medical doctors to nurses and from nurses to community health workers. Such task shifting is not easy to achieve but undoubtedly needed.
  
  
  OBJECTIVE
  This paper raises issues about the involvement of new actors(3) without precise redefinitions of roles and task-shifting procedures. We take the example of a 'Centre de Prévention et de Dépistage Volontaire du VIH/sida'(4) in one major town of the Far-North province of Cameroon (Central Africa).
  
  
  METHODS
  The study was qualitative. Observations were carried out in the service and in-depth interviews conducted with health workers and actors of Cameroon's National AIDS Control Committee. These interviews were recorded and transcribed. The material was analysed using keywords. KEY RESULT: The involvement of new actors in a context of human resources for health shortage and health system crisis creates confusion and role conflicts, which lead to frustration. It favours the appearance of chinks within which these new actors slip and 'find their way' in the system; it finally raises problems related to their legitimacy and position within the existing hierarchy. KEY POLICY MESSAGE: It is necessary, when involving new staff members (particularly when they do not belong to internationally recognized health professionals such as nurses, doctors and pharmacists), to redefine roles and build precise task-shifting procedures so that everyone may still have a place in the whole system and feel useful.
authors.affiliation: UMR912 (INSERM-IRD-U2) Sciences Economiques et Sociales, Systèmes de santé, Sociétés, Observatoire Régional de la Santé (PACA), Marseille, France. Josiane.Tantchou@ird.fr
authors.forename: J C Y Tantchou
authors.initials: JC
authors.lastname: Yakam
authors.forename: M-E
authors.initials: ME
authors.lastname: Gruénais
mesh_terms: D015492:AIDS Serodiagnosis; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002163:Cameroon / Q000453:epidemiology; D003150:Community Health Workers / Q000458:organization & administration; D003220:Conflict, Psychological; D003376:Counseling / Q000458:organization & administration*; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006282:Health Personnel / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D006801:Humans; D007400:Interprofessional Relations; D009313:National Health Programs / Q000458:organization & administration; D020380:Needs Assessment; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000458:organization & administration; D009936:Organizational Innovation; D024382:Professional Role / Q000523:psychology*; D011634:Public Health / Q000379:methods; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D000078329:Workforce; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents