This review paper examines key opportunities and challenges presented when task shifting is used to rapidly expand human resource capacity to address HIV/AIDS. Opportunities include: increasing access to life-saving treatment; improving workforce skills mix and health system efficiency; enhancing the role of the community; cost savings; and reducing attrition and international ‘brain drain’.
This paper outlines the importance of a systems approach when task shifting to CHWs, arguing that it cannot work unless close attention is paid to both the systems that support successful implementation and to needed expansion of human resources within the overall health care system. The paper incorporates discussion on taking a systems approach; the planning and regulatory systems; education, selection and training systems; supervision and psycho-social support systems; referral systems; and strengthening the related health workforce.
This review examines randomized control trials that tested the effectiveness of lay health worker (LHW) interventions on improving Maternal and Child Health (MCH) and addressing key high-burden diseases in low and middle income countries. The authors found that the use of LHWs in health programs showed benefits when compared with standard care in promoting immunization and breastfeeding uptake, reducing mortality and morbidity and in improving TB treatment outcomes.
This paper describes the contribution of the non-governmental organization Zanmi Lasante (ZL) to scaling up HIV prevention and treatment and improving primary health care services in the public health system in Haiti. ZL’s model utilizes CHWs to supervise antiretroviral therapy and provide community outreach, including active case finding and outreach to marginalized populations. The case study analyses key components of the CHWs work, their self-perception, and their roles in enhancing community uptake of services and targeting vulnerable groups.
This study examine the impact of using CHWs in the Katan Health Zone in Zaire to reduce malaria morbidity and mortality. CHWs were trained and supported to administer timely and effective treatment for presumptive malaria attacks. The authors conclude that the introduction of dedicated CHWs can lead to improved access to and utilization of health care for malaria and this in turn results in declining malaria morbidity and mortality. However, the study notes that the deployment of dedicated CHWs may not be sustainable.
In 2008, Malawi piloted the distribution of the injectable contraceptive DMPA by Health Surveillance Assistants. This report presents lessons learned, during the initial training and implementation roll-out, which will be valuable for other countries planning similar community-based distribution systems. The report pays particular attention to the supply chain implications of distributing family planning commodities to “the last mile.”
In Kenya, with USAID support, the Population Council's FRONTIERS in Reproductive Health project supported the scale up of a model that enabled women to give birth at home or to be referred to a hospital when attended by a self-employed skilled midwife living in the community. This report describes the project and provides recommendations on skills development for the community midwives in: maintaining quality of care, business skills and support to achieve financial sustainability, and strengthening linkages among midwives, the formal health sector and District Health Management Teams.
WHO puts forward a set of 22 recommendations to provide guidance to countries considering adopting or extending a task-shifting approach. These recommendations were developed through a one-year process of country consultation, extensive data-gathering, and broad consultation among a wide range of experts and stakeholders.
This report summarizes the best available evidence regarding the design and implementation of "task shifting" policies extending the use of non-medically trained primary health care workers to deliver cost-effective maternal and child health interventions. The report’s purpose is to inform deliberations and decision-making among policymakers and stakeholders.
This paper reviews the development of the Community-based Heath Planning and Services (CHPS) Initiative, describes the processes of implementation and relates the initiative to the principles of scaling up organizational change which it embraces. Over a 2-year period, 104 out of 110 districts in Ghana started CHPS, employing strategies tested in the successful Navrongo experiment to guide national health reforms and mobilize volunteerism, resources and cultural institutions for supporting community-based primary health care.