Coronavirus Disease 2019 (COVID-19)

Task Shifting and Sharing Examples by Specific Medical Service

The following section describes of tasks under specific health programs that may be shifted or shared. It is assumed that shifting and/or sharing of these tasks comes with adequate training, monitoring, and supervision as described in this document.

  1. Human immunodeficiency virus (HIV) prevention and treatment

With countries moving toward the  WHO’s “Treat All”7 recommendation, there is a need to initiate more HIV-infected persons into antiretroviral therapy (ART). In resource-limited settings, task shifting is an approach that can address clinician shortages.

According to the WHO1, CHWs can: 1) distribute refills of ART to adults, adolescents, and children living with HIV through home visits, community pick-up points, community adherence groups, etc;1  2) implement community-based education, preventive interventions;1 3) provide combined HIV and tuberculosis observed treatment; and 4) offer psychosocial support to patient and family. Non-physician clinicians, midwives, and nurses can conduct the point-of-care viral load testing,8 initiate first-line ART or post-exposure prophylaxis,9 and maintain ART. CHWs and health facility staff can be mobilized, trained, and engaged in delivering the WHO endorsed, Interpersonal Psychotherapy (IPT-G) for Postpartum Adolescent (PPA) mothers living with HIV.10

  1. Tuberculosis(TB) prevention and treatment

CHWs can screen for TB by identifying people with symptoms (e.g. coughing for more than 2 weeks, coughing up blood, fever, night sweats,  unintentional weight loss). Medical doctors, non-physician clinicians, or nurses1 may initiate TB treatment after the first episode of pulmonary or extra-pulmonary TB based on clinical symptoms, while awaiting, in lieu of, or in addition to sputum results. They can also monitor TB response to treatment and recognize medication side effects.

  1. Maternal, newborn, and child health services

WHO issued evidence-based recommendations11 to facilitate universal access to key, effective maternal and newborn interventions through the optimization of health workers’ roles. One way of facilitating universal access is to mobilize available human resources and provide short periods of additional training for health workers to take on activities they have not undertaken before.

 Maternal and Newborn
CHWs, auxiliary nurses, and  midwives can promote appropriate health-related behaviors and conduct home visits to measure the blood pressure12 of pregnant women. CHWs can be trained to identify main danger signs13 of pregnancy complications and refer obstetric emergencies to a higher level of care. CHWs and auxiliary nurses may administer misoprostol to prevent or treat postpartum hemorrhage (PPH) before referral. Auxiliary nurses may administer intravenous fluids for resuscitation and administer oxytocin as part of PPH treatment. Auxiliary nurse midwives may deliver neonatal resuscitation.

The coverage of maternal and neonatal care interventions, including antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC) can be increased14 by strengthening CHWs.

Child health
CHWs can identify and treat children who have uncomplicated pneumonia, diarrhea or malaria, identify young infants with serious illness and improve early health facility care seeking.15

  1. Non-communicable diseases (NCDs) such as hypertension, diabetes, obesity, asthma, and kidney disease

Studies show that task shifting from physicians to other health care workers, including CHWs, nurses16 and nurse practitioners, is an effective strategy for improving access to health care17 for NCDs,  especially when coupled with health system restructuring.  They provide counseling for patients and family members on medication adherence, address any general concerns,18 and screen patients with confirmed COVID-19 for a history of preexisting hypertension, diabetes, obesity, asthma, and kidney disease. CHWs can deliver interventions to diagnose and treat,19 using blood pressure monitoring devices, glucometers, pulse oximeters, and nebulizers.

  1.  Mental health

Integrating mental health services into primary care20 and shifting the provision21 of evidence-based psychosocial treatments to non-specialist health workers such as community health workers, lay persons, and other frontline health workers has emerged as a highly promising approach.

The “task sharing” in mental health can be achieved either by mobilizing the human resources currently available by expanding their current roles to include counselling (termed the “designated approach”) or by re-distributing funding to allow for the employment of additional counsellors (termed the “dedicated approach” by the WHO in 2007).22

According to WHO6 CHWs, nurses, psychosocial workers, or community social workers in humanitarian settings can raise awareness about use (MNS) care and refer people with MNS conditions to seek help at a clinic. CHWs, nurses, psychosocial workers or community social workers in humanitarian settings can also provide psychological first aid, brief psychological treatments, facilitate self-help groups, and teach stress management.

  1. Surgery and Anesthesia

Task sharing in surgery and anesthesia23 can enhance access to safe and cost-effective surgery. Task sharing is preferred24 to task shifting to maintain safety of surgical procedures in low-resource settings. Most task-sharing25 targets non-physician clinicians and non-specialist physicians. Approaches to task sharing may include: engaging nursing, physician, and other health provider groups in the planning and implementation of task sharing activities from the initial stages to delineate roles and ameliorate inefficiencies arising from role overlap among cadres; constructing a portfolio of priority procedures and develop a framework that stratifies them by complexity, learning curve, and risk to facilitate the identification of procedures that may be safely and effectively performed by non-specialists with appropriate training and mentorship;  placing training centers and clinical residencies (or substantial phases of training) in areas where resources and limitations match those in the areas to which the workforce will be deployed to assure that training is attuned to the local needs and circumstances; and designing and implementing system for supervision and mentorship to both enhance patient safety and foster professional development and collaboration.

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