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      Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa.

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          Abstract

          Sub-Saharan Africa is facing a crisis in human health resources due to a critical shortage of health workers. The shortage is compounded by a high burden of infectious diseases; emigration of trained professionals; difficult working conditions and low motivation. In particular, the burden of HIV/AIDS has led to the concept of task shifting being increasingly promoted as a way of rapidly expanding human resource capacity. This refers to the delegation of medical and health service responsibilities from higher to lower cadres of health staff, in some cases non-professionals. This paper, drawing on Médecins Sans Frontières' experience of scaling-up antiretroviral treatment in three sub-Saharan African countries (Malawi, South Africa and Lesotho) and supplemented by a review of the literature, highlights the main opportunities and challenges posed by task shifting and proposes specific actions to tackle the challenges. The opportunities include: increasing access to life-saving treatment; improving the workforce skills mix and health-system efficiency; enhancing the role of the community; cost advantages and reducing attrition and international 'brain drain'. The challenges include: maintaining quality and safety; addressing professional and institutional resistance; sustaining motivation and performance and preventing deaths of health workers from HIV/AIDS. Task shifting should not undermine the primary objective of improving patient benefits and public health outcomes.

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          Author and article information

          Journal
          Trans. R. Soc. Trop. Med. Hyg.
          Transactions of the Royal Society of Tropical Medicine and Hygiene
          Elsevier BV
          1878-3503
          0035-9203
          Jun 2009
          : 103
          : 6
          Affiliations
          [1 ] Médecins Sans Frontières, Medical Department, Brussels Operational Center, Rue de Gasperich, Luxembourg. zachariah@internet.lu
          Article
          S0035-9203(08)00423-9
          10.1016/j.trstmh.2008.09.019
          18992905
          c1d16cbf-3091-4cc5-b903-ad6deb9b4be4
          History

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