Skills mix, task shifting and competence

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Skills mix, task shifting and competence

• Potential for workforce planning
• Lois Schaefer USAID
• Barbara Stilwell Capacity Project

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In this session we will

• Describe different models of task shifting
  currently in use
• Describe the realigning tasks model
• Discuss methods of assessing competencies and
  using data generated from such an assessment
• Suggest ways of using task shifting to improve
  workforce efficiencies

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With your neighbor .

• Discuss what you mean, or what you think is
  meant, by task shifting

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Some current task shifting practices

• Shifting a single task, or a limited, related set
  of tasks, from one cadre to another
• Creating a new cadre to provide a specific set of
  services, usually to make those services
  available closer to those in need
• Community-based volunteers
• Often happens informally or ad hoc

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What we do and dont mean by task shifting

• Improving the efficiency of the current workforce
  through a more rational division of tasks between
  various cadres of health workers
• Does not always imply shifting tasks to a lesser
  qualified worker
• It may be a temporary solution to workforce
  shortages, or may permanently change workforce
  structure

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Realigning tasks 1
Preparation for competence
Tasks
Role of Midwife
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Realigning tasks 2
Delivering antibiotics - nurses
Delivering babies - midwife
Individuals may have competencies from several
frameworks
CHW? Community midwife?
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Realigning tasks 3

• Individuals competent to perform tasks are
  deployed appropriately in teams

Teamwork the sum of the whole
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Challenges

• Measuring competencies at all levels when?

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More Challenges

• Moving away from roles
• Political implications the power of some
  interest groups
• Legal implications practice acts
• Public education Ive always seen a doctor for
  this and I always will
• The inverted donut
• Importance of role identification

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The inverted doughnut (Charles Handy)
The discretionary part of our roles
The solid core of our roles
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Ask each other..

• What do you think might be the effects if you
  changed the contents of your doughnut? (on you,
  on your co-workers, on your job)
• How would you set about dealing with the effects
  of role change if you were a manager?

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Issues in implementing task shifting

• Always seem to shift to the same cadres
• Swaziland nurses are becoming technicians
  rather than caregivers
• Support for those receiving new tasks is often
  inadequate or nonexistent
• Training/education
• Supervision
• Uganda nursing assistants are taking on nursing
  role due to shortage of nurses, but there is no
  one to supervise them due to same shortage

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More issues

• Incentives/motivation/salaries
• Per test fees paid to lab technicians are not
  paid to nurses when they became responsible for
  performing the same test
• New cadres, especially at the community level
  and/or if volunteers, are not linked to the
  formal health care system

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Yet more challenges

• Making it easy to progress through levels
• Educational system that permits re-entry
• Competencies described at all levels
• Having a clinical career ladder
• Need buy-in from professional association
• Dealing with regulation of practice
• Is this a short term or a long term change of
  role?
• Again, need support from professional
  associations

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A Better Approach Ethiopia

• Task shifting is part of a larger re-engineering
  of 7 core processes in the health care system
  (policies, etc. in place) national level
  advocacy and planning
• Re-introduction of mid-level health officer cadre
  (3000 prepared so far)
• Well developed curriculum
• Accelerated program for nurses to upgrade to HO
• Will introduce Masters degree in emergency
  surgical skills and another in public health for
  HOs possible PhD prog.
• So there is a career path
• Have a single centralized council for all the
  professions with representation from the
  professional associations

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A systems issue
Individuals, families, communities
Facilities
Prof assoc 1
Nurses
CHW
Legal framework
Education system
equipment
The Health System
Physicians
PA2