4 - 4 - Video 3.4 Task Shifting vs. Task Sharing (8 47), Childbirth A Global Perspective
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Hello my name is Patricia Riley andI'm here at Lullwater Preserveon the Emory University campus.And I'm right down the street from CDC,the Centers forDisease Control and Prevention.I serve as a senior technical advisor inthe division of global HIV/AIDS at CDC.I'm also a nurse-midwife,and I've been working inthe field of global Human Resources forHealth, or HRH, for the past decade.Where health work force issues haveplayed a critical role in designing andexpanding HIV service provision,and maternal and newborn centers.In light of the global workforceshortages previously described byDoctor Martha Rogers,successful implementation of public healthinterventions targeting mothers andnewborns, requires innovativeworkforce strategies.Cash shifting orcash sharing are recognized asacceptable HRH approaches toexpanding healthcare delivery.Both cash shifting and cash sharinghave been incorporated into a variety ofglobal health initiatives includingmaternal and newborn health.So over the next several minutes, I'lldiscuss these terms in greater detail,describe recent research findingsregarding this approach, andpresent relati,relevant policy implications.The learning objectives forthis lecture on the impact ofthe healthcare workforceshortage on maternal andnewborn care include first,identifying the terms task shifting andtask sharing, and distinguishing thedifference between these two approaches.Secondly recognizing the scientificevidence base of task shifting andtask sharing in maternal and newborn care.Especially with regards to preventingmother to child transmission ofthe HIV virus,an intervention commonly known as PMTCT.Thirdly, understandingregulatory concerns andpolicy implications regardingcash shifting and cash sharing.In 2008 Dr. Margaret Chan,Director General ofthe World Health Organizationspear headed global consensus.That recognized an insufficient capacityof the health work force to respond tomajor health initiatives.She, along with other global leaders,noted that without urgent improvements inthe performance of health systems,including significant strengthening ofHRH, the world would fail to meet themillennium development goals for health.Additionally, there was universalrecognition that in order to stem the tideof the HIV epidemic more innovativeways were needed to ensure accessible,equitable, and quality health care thus,the two inner linked emergenciesthe HIV epidemic and human resources forhealth shortages provided the impetus forformulating new workforce strategies fordelivering health care.This strategy was officiallytermed task shifting.As defined by the World HealthOrganization their resource guide Taskshifting: global recommendations andguidelines.Task shifting is the name given to aprocess in which specific tasks are movedwhere appropriate, to health workers withshorter training and fewer qualifications.By recognizing the workforce in this way,task shifting efficiently usesexisting human resources andeases bottle necks and service delivery.In situations where additionalstaffing is needed,task shifting also involves the delegationof clearly delineated healthtasks to newly created cadres of healthworkers, such as community health workers,who receive specificcompetency based training.The more recent term of task sharing wasintroduced in 2010 with the institute ofmedicine's report preparing forthe future of HIV/AIDS in Africa.As noted in their report, task sharingemphasizes a knowledge-based requirementfor delegated roles and responsibilitiesand underscores the involvement of health,professional collaborationwhen providing care.Whereas task shifting focuseson the delegation of duties,task sharing incorporatesworkplace strategies that buildupon the collective input ofthe health unit or health team.As described by the institute of medicine,task sharing is neither hierarchical, norterritorial and allows roles to expand orcontract according to need asbefitting low resource environments.Because cash sharing is a newer concept,specific research regarding thisapproach is still emerging.Since most of the scientificliterature to date describes taskshifting practices in health caresettings I will mostly refer tothis term unless task sharingapproaches are specifically noted.Over the past six years task shifted workplace strategies have integrated a varietyof health programs including maternal andreproductive health,pediatric HIV care and the voluntarymale medical circumcision program.A recent HIV intervention that hasbeen shown to reduce mens' risk ofHIV acquisition by at least 60%.The following video that you are about tosee illustrates how task shifting a malecircumcision program to Kenyan nursemidwives, not only resulted in programperformance that surpassed annual targetsover a three year period, but alsocoincided with decreased HIV prevalenceamong circumcised males in the area.[MUSIC]>> Western Kenya has the highestHIV/AIDS burden in the country.[MUSIC]But a simple medical procedure,voluntary medical male circumcision,has been proven to dramaticallyreduce the risk of contracting HIV.In january 2014, up to three yearsof work, medical teams trained andsupported by USAID's,APHIA PLUS Western project andJhpiego helped their 100,000thclient get circumcised.Joash Otieno Malela is a 26year old farmer, husband anda father of 2, living inHoma Bay County in Western Kenya.On an ordinary Tuesday,a community health worker visited Joashat his home to talk about the benefitsof voluntary medical male circumcision.After thinking it through, anddiscussing about circumcision with hiswife, Joash decided to get the procedure[MUSIC]Right away,the community health walker walkedwith Joash to a nearby public healthfacility where Joash met up with othermen who are waiting to get circumcised.[MUSIC]Joash was told more about the procedure.A counselor explained how to care forhimself in order to hear properly.Before getting the procedure,Joash agreed to be tested for HIV andlearned how to protect himself againstHIV by using condoms in the future.In less than an hour, the procedure wascompleted and Joash was on his way home[MUSIC]The very next day, we found Joashin the market with his friends.[MUSIC]
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