1. TITLE from VIEW and SLIDE MASTER | 27 July 2006 1 |1 | Task shifting: rational redistribution of tasks among health workforce teams Annette Mwansa Nkowane HRH Department Health Systems and Services World Health Organization

2. TITLE from VIEW and SLIDE MASTER | 27 July 2006 2 |2 | 200 1000 800 600 400 (density HW/100,000p) 55 Doctors/100,000p 69 113 7 Nurses/100,000p 25 388 1 Malawi Botswana S. Africa 29 256 UK 937 Number of doctors and nurses in selected countries Zambia 241 WHR, 2006

3. TITLE from VIEW and SLIDE MASTER | 27 July 2006 3 |3 | 20% 40% 60% 23% 38% 42% DoctorsNursesOthers % in rural localities Urban vs. rural distribution of health workers WHR, 2006

4. TITLE from VIEW and SLIDE MASTER | 27 July 2006 4 |4 | Number of community health workers per 1000 population

5. TITLE from VIEW and SLIDE MASTER | 27 July 2006 5 |5 | First contact with health system for people living with HIV

6. TITLE from VIEW and SLIDE MASTER | 27 July 2006 6 |6 | Task Shifting

7. TITLE from VIEW and SLIDE MASTER | 27 July 2006 7 |7 | Task Shifting The key questions: – Impact on coverage? – Impact on quality of services? – Cost-effective? – Acceptable by service users?

8. TITLE from VIEW and SLIDE MASTER | 27 July 2006 8 |8 | 1,000,000 2005 2006 2007 500,000 Number of people tested for HIV 500 000 1 600 000 436 854 Task shifting and HIV T&C coverage in Ethiopia CHWs performing HIV T&C 1,500,000 MOH Ethiopia, 2007

9. TITLE from VIEW and SLIDE MASTER | 27 July 2006 9 |9 | ART delivery by cadre in the US Performance is similar or higher for PA compared to physicians. CadreAdjusted rate (95% CI)P-value ID physician 0.84 (0.81-0.86)0.29 GP HIV expert 0.83 (0.80-0.85)0.51 GP non HIV exp 0.75 (0.65-0.80)0.04 Physician Asst 0.82 (0.78-0.85)Ref Wilson et al, Annals of Internal Medicine, 2005

10. TITLE from VIEW and SLIDE MASTER | 27 July 2006 10 | TB treatment in hospitals and communities WHO, 2003

11. TITLE from VIEW and SLIDE MASTER | 27 July 2006 11 | Cost-effectiveness of task shifting in TB care WHO, 2003

12. TITLE from VIEW and SLIDE MASTER | 27 July 2006 12 | How confident and satisfied are you with the services provided by CHWs? 67% 28% 3% Extremely satisfied Very satisfied Not satisfied Fairly satisfied 3% WHO commissioned study on Task Shifting, Central Plateau, Haiti

13. TITLE from VIEW and SLIDE MASTER | 27 July 2006 13 | The essential requirements for task shifting – Quality assurance – Regulatory framework – Sustainability – Involvement of service users

14. TITLE from VIEW and SLIDE MASTER | 27 July 2006 14 | Thank you