Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia
<p>Abstract</p> <p>The World Health Organization advocates task-shifting, the process of delegating clinical care functions from more specialized to less specialized health workers, as a strategy to achieve the United Nations Millennium Development Goals. However, there is a dearth...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2009-01-01
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| Series: | BMC Health Services Research |
| Online Access: | http://www.biomedcentral.com/1472-6963/9/5 |
| _version_ | 1811284064485769216 |
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| author | Chi Harmony F Mwango Albert Chi Benjamin H Chapula Bushimbwa Morris Mary B Mwanza Joyce Manda Handson Bolton Carolyn Pankratz Debra S Stringer Jeffrey SA Reid Stewart E |
| author_facet | Chi Harmony F Mwango Albert Chi Benjamin H Chapula Bushimbwa Morris Mary B Mwanza Joyce Manda Handson Bolton Carolyn Pankratz Debra S Stringer Jeffrey SA Reid Stewart E |
| author_sort | Chi Harmony F |
| collection | DOAJ |
| description | <p>Abstract</p> <p>The World Health Organization advocates task-shifting, the process of delegating clinical care functions from more specialized to less specialized health workers, as a strategy to achieve the United Nations Millennium Development Goals. However, there is a dearth of literature describing task shifting in sub-Saharan Africa, where services for antiretroviral therapy (ART) have scaled up rapidly in the face of generalized human resource crises. As part of ART services expansion in Lusaka, Zambia, we implemented a comprehensive task-shifting program among existing health providers and community-based workers. Training begins with didactic sessions targeting specialized skill sets. This is followed by an intensive period of practical mentorship, where providers are paired with trainers before working independently. We provide on-going quality assessment using key indicators of clinical care quality at each site. Program performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. From 2005 to 2007, we trained 516 health providers in adult HIV treatment; 270 in pediatric HIV treatment; 341 in adherence counseling; 91 in a specialty nurse "triage" course, and 93 in an intensive clinical mentorship program. On-going quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. Our task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful, long-term solutions to the human resource crisis are also urgently needed to expand the number of providers and to slow staff migration out of the region.</p> |
| first_indexed | 2024-04-13T02:22:57Z |
| format | Article |
| id | doaj.art-5fc9c7e926d140828073189e52155ca9 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-13T02:22:57Z |
| publishDate | 2009-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-5fc9c7e926d140828073189e52155ca92022-12-22T03:06:53ZengBMCBMC Health Services Research1472-69632009-01-0191510.1186/1472-6963-9-5Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, ZambiaChi Harmony FMwango AlbertChi Benjamin HChapula BushimbwaMorris Mary BMwanza JoyceManda HandsonBolton CarolynPankratz Debra SStringer Jeffrey SAReid Stewart E<p>Abstract</p> <p>The World Health Organization advocates task-shifting, the process of delegating clinical care functions from more specialized to less specialized health workers, as a strategy to achieve the United Nations Millennium Development Goals. However, there is a dearth of literature describing task shifting in sub-Saharan Africa, where services for antiretroviral therapy (ART) have scaled up rapidly in the face of generalized human resource crises. As part of ART services expansion in Lusaka, Zambia, we implemented a comprehensive task-shifting program among existing health providers and community-based workers. Training begins with didactic sessions targeting specialized skill sets. This is followed by an intensive period of practical mentorship, where providers are paired with trainers before working independently. We provide on-going quality assessment using key indicators of clinical care quality at each site. Program performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. From 2005 to 2007, we trained 516 health providers in adult HIV treatment; 270 in pediatric HIV treatment; 341 in adherence counseling; 91 in a specialty nurse "triage" course, and 93 in an intensive clinical mentorship program. On-going quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. Our task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful, long-term solutions to the human resource crisis are also urgently needed to expand the number of providers and to slow staff migration out of the region.</p>http://www.biomedcentral.com/1472-6963/9/5 |
| spellingShingle | Chi Harmony F Mwango Albert Chi Benjamin H Chapula Bushimbwa Morris Mary B Mwanza Joyce Manda Handson Bolton Carolyn Pankratz Debra S Stringer Jeffrey SA Reid Stewart E Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia BMC Health Services Research |
| title | Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia |
| title_full | Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia |
| title_fullStr | Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia |
| title_full_unstemmed | Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia |
| title_short | Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia |
| title_sort | use of task shifting to rapidly scale up hiv treatment services experiences from lusaka zambia |
| url | http://www.biomedcentral.com/1472-6963/9/5 |
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