Human Resources for Health in Maternal, Neonatal and - HRH ...

Figure 23 The Task Shifting Process and requirements
(Samb 2008)
A recent AMREF report draws from the WHO recommendations and calls for Ministry of
Health and Professional Medical Association policies in Africa to allow task shifting to lower
cadres of health workers. It highlights task shifting to cadres with basic clinical and
community health competencies, such as enrolled nurses and clinical officers at community
level in order to bring services closer to the PHC level. Donors should support these polices
and the increases in health worker responsibility should be accompanied by increased salaries
and other incentives (Hall 2007). Bluestone‘s review of task shifting outlines the steps
required and highlights the need to gather client and community perspectives to ensure that
skill mix changes will be acceptable to those that they are supposed to serve. This includes
consideration of gender, age language, ethnicity and geography (2006).
The literature reporting on experience of tasking shifting in MNRH at community level is
limited but indicates that specific tasks can be transferred to lower cadres. Task shifting the
administration of injectable contraceptives to community-based health workers has been
found to result in safe and effective practice (Stanback, Mbonye et al. 2007;
WHO/USAID/FHI 2009). In the last decade, CHWs have provided three-monthly injectable
contraceptive depot-medroxyprogesterone acetate (DMPA) to women in more than a dozen
countries, including Afghanistan, Bangladesh, Bolivia, Guatemala, Ethiopia, Haiti,
Madagascar, Malawi, Nepal, and Uganda. Nurse auxiliaries have also been found to be
effective providers of intrauterine devices for contraception in Guatemala and Honduras
(Vernon 2009). A key study in RH found that task shifting to nurses of first trimester abortion
care to be a successful approach. The results demonstrated that manual vacuum aspiration
abortions performed by government-trained and accredited nurses, midwives and mid-level
health-care providers in South Africa and Viet Nam were comparable in terms of safety and
acceptability to those performed by doctors (WHO 2008). A recent forum on task shifting
identified a number of examples in MNRH at the community level (HRH Exchange 2009). In
India a number of tasks have been shifted to ASHAS who have been given responsibility for
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