title: The reality of task shifting in medicines management- a case study from Tanzania.
abstract: OBJECTIVE
  Tanzania suffers a severe shortage of pharmaceutical staff. This negatively affects the provision of pharmaceutical services and access to medicines, particularly in rural areas. Task shifting has been proposed as a way to mitigate the impact of health worker shortfalls.The aim of this study was to understand the context and extent of task shifting in pharmaceutical management in Dodoma Region, Tanzania. We explored 1) the number of trained pharmaceutical staff as compared to clinical cadres managing medicines, 2) the national establishment for staffing levels, 3) job descriptions, 4) supply management training conducted and 5) availability of medicines and adherence to Good Storage Practice.
  
  
  METHODS
  A cross-sectional study was conducted in 270 public health facilities in 2011. A pre-tested questionnaire was administered to the person in charge of the facility to collect data on staff employed and their respective pharmaceutical tasks. Availability of 26 tracer medicines and adherence to Good Storage Practice guidelines was surveyed by direct observation. The national establishments for pharmaceutical staffing levels and job descriptions of facility cadres were analysed.
  
  
  RESULTS
  While required staffing levels in 1999 were 50, the region employed a total of only 14 pharmaceutical staff in 2011. Job descriptions revealed that, next to pharmaceutical staff, only nurses were required to provide dispensing services and adherence counselling. In 95.5% of studied health facilities medicines management was done by non-pharmaceutically trained cadres, predominantly medical attendants. The first training on supply management was provided in 2005 with no refresher training thereafter. Mean availability of tracer medicines was 53%, while 56% of health facilities fully met criteria of Good Storage Practice.
  
  
  CONCLUSIONS
  Task shifting is a reality in the pharmaceutical sector in Tanzania and it occurs mainly as a coping mechanism rather than a formal response to the workforce crisis. In Dodoma Region, pharmacy-related tasks and supply management have informally been shifted to clinical staff without policy guidance, explicit job descriptions, and without the necessary support through training. Implicit task shifting should be recognized and formalized. Job orientation, training and operational procedures may be useful to support non-pharmaceutical health workers to effectively manage medicine supply.
authors.affiliation: Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Karin A
authors.initials: KA
authors.lastname: Wiedenmayer
authors.affiliation: Regional Medical Office, P.O Box 320 Shinyanga, Shinyanga Region Tanzania.
authors.forename: Ntuli
authors.initials: N
authors.lastname: Kapologwe
authors.affiliation: District Medical Office, P.O Box 1126 Chamwino, Dodoma Region Tanzania.
authors.forename: James
authors.initials: J
authors.lastname: Charles
authors.affiliation: Health Promotion and System Strengthening Project, P.O Box 29 Dodoma, Dodoma Region Tanzania.
authors.forename: Fiona
authors.initials: F
authors.lastname: Chilunda
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors.forename: Siana
authors.initials: S
authors.lastname: Mapunjo
keywords: Health workforce crisis; Medicines management; Pharmaceutical staff; Tanzania; Task shifting