WHO recommendations and guidelines on task shifting

1
WHO recommendations and guidelines on task
shifting
Francesca Celletti Health Systems and Services
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Where is the critical shortage of health workers?
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The challenges to scale up services for HIV, TB,
malaria, and immunization
HIV/UA assessment report
Global Plan to stop TB
World Malaria report
GAVI/Norad report

• Inadequate financing
• HR crisis
• Affordable commodities
• Stigma, discrimination
• Accountability

• Partnership alignment
• Inadequate financing
• Laboratory capacity
• HR crisis
• Quality drugs

• Drug efficacy
• Information system
• Inadequate financing
• HRH and Community services
• - ME

• HR crisis
• Inadequate financing
• Leadership and management
• Inter-agency coordination

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First contact with health system for people
living with HIV
WHO study on Task Shifting, Central Plateau,
Haiti
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Task Shifting
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Task Shifting

• The key questions
• Impact on coverage?
• Impact on quality of services?
• Cost-effective?
• Acceptable by service users?

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Task shifting and HIV TC coverage in Ethiopia
1 600 000
1,500,000
Number of people tested for HIV
CHWs performing HIV TC
1 ,000,000
500 000
500,000
436 854
2006
2007
2005
MOH Ethiopia, 2007
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Family planning in Tanzania
76
75
( coverage and access)
50
50
55
25
20
11.6
1990
1990
1996
1996
Attendance of FP clinic
Use of oral contraceptive
JOICFP, 1996
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ART delivery by cadre in the US

• Performance is similar or higher for PA compared
  to physicians.

Wilson et al, Annals of Internal Medicine, 2005
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Selected child health indicators in Brazil
1 year
2 year
3 year
Baseline
Cesar et al, Social Science and Medicine, 2000
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TB treatment in hospitals and communities
WHO, 2003
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Cost-effectiveness of task shifting in TB care
WHO, 2003
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How confident and satisfied are you with the
services provided by CHWs?
Not satisfied
Fairly satisfied
3
3
3
Very satisfied
28
67
Extremely satisfied
WHO study on Task Shifting, Central Plateau,
Haiti
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The essential requirements for task shifting

• Quality assurance
• Regulatory framework
• Sustainability
• Involvement of service users

WHO global recommendations and guidelines on
Task Shifting
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Thank you