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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Use of task-shifting to rapidly scale-up HIV treatment services: Experiences from Lusaka, Zambia
BMC Health Services Research, Volume 9, Article 5, Year 2009
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Description
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. © 2009 Morris et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Morris, Mary B.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Tambatamba, Bushimbwa
Zambia, Lusaka
Lusaka District Health Management Team
Chi, Benjamin H.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Mwango, Albert J.
Zambia, Lusaka
Zambian Ministry of Health
Chi, Harmony F.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Mwanza, Joyce
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Manda, Handson
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Bolton Moore, Carolyn
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Pankratz, Debra S.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Stringer, Jeffrey S.A.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Reid, Stewart E.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Statistics
Citations: 177
Authors: 11
Affiliations: 4
Identifiers
Doi:
10.1186/1472-6963-9-5
e-ISSN:
14726963
Research Areas
Health System And Policy
Infectious Diseases
Study Approach
Systematic review
Study Locations
Zambia