Task shifting: the answer to the human resources crisis in Africa?
Task shifting: the answer to the human resources crisis in Africa?
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DOI：
10.1186/1478-4491-7-49
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发表时间：
2009-06-21
影响因子：
4.5
通讯作者：
Sanders, David
中科院分区：
文献类型：
--
作者：
Lehmann, Uta;Van Damme, Wim;Sanders, David
自2006年《世界卫生报告》提倡加强社区参与和系统地将任务委托给专业程度较低的干部以来，关于任务转移的权宜之计、有效性和方式一直存在大量辩论。把任务从一个干部委派给另一个干部，以前常被称为代换，并不是一个新概念。它在许多国家已经使用了几十年，要么作为对紧急需要的反应，要么作为在初级和二级提供适当护理的一种方法，特别是在人手不足的农村设施中，以提高质量和降低费用。然而，由于艾滋病毒/艾滋病流行病造成的护理需求迅速增加以及许多非洲国家人力资源危机的加剧，使任务转移的概念和做法变得更加突出和紧迫。此外，还出现了这样一个问题，即任务转移和增加社区参与是否不仅仅是解决艾滋病毒/艾滋病危机的短期解决办法，而且可以促进初级卫生保健方法的复兴，作为卫生系统危机的答案。在这篇评论中，我们认为，虽然任务转移有很大的希望，但任务转移的任何长期成功都取决于严肃的政治和财政承诺。我们认为，这需要对保健小组进行全面和综合的重新配置，改变实践范围和监管框架，加强培训基础设施，以及提供可靠的中长期资金，时间框架为20至30年，而不是3至5年。社区参与的概念和实践需要重新审视。最重要的是，任务转移战略要求各国政府发挥领导作用，确保建立有利的监管框架；推动相关政策的实施；指导和支持培训机构，确保资源充足；并利用多方利益相关者的支持。有了这样的领导和向具有相关经验的国家（例如巴西、埃塞俄比亚、马拉维、莫桑比克和赞比亚）学习的意愿，任务转移确实可以对建立可持续、具有成本效益和公平的卫生保健系统作出重要贡献。没有它，任务转移就有可能成为又一项不成功的卫生部门改革举措。
Ever since the 2006 World Health Report advocated increased community participation and the systematic delegation of tasks to less-specialized cadres, there has been a great deal of debate about the expediency, efficacy and modalities of task shifting.The delegation of tasks from one cadre to another, previously often called substitution, is not a new concept. It has been used in many countries and for many decades, either as a response to emergency needs or as a method to provide adequate care at primary and secondary levels, especially in understaffed rural facilities, to enhance quality and reduce costs. However, rapidly increasing care needs generated by the HIV/AIDS epidemic and accelerating human resource crises in many African countries have given the concept and practice of task shifting new prominence and urgency. Furthermore, the question arises as to whether task shifting and increased community participation can be more than a short-term solution to address the HIV/AIDS crisis and can contribute to a revival of the primary health care approach as an answer to health systems crises.In this commentary we argue that, while task shifting holds great promise, any long-term success of task shifting hinges on serious political and financial commitments. We reason that it requires a comprehensive and integrated reconfiguration of health teams, changed scopes of practice and regulatory frameworks and enhanced training infrastructure, as well as availability of reliable medium-to long-term funding, with time frames of 20 to 30 years instead of three to five years. The concept and practice of community participation needs to be revisited.Most importantly, task shifting strategies require leadership from national governments to ensure an enabling regulatory framework; drive the implementation of relevant policies; guide and support training institutions and ensure adequate resources; and harness the support of the multiple stakeholders. With such leadership and a willingness to learn from those with relevant experience (for example, Brazil, Ethiopia, Malawi, Mozambique and Zambia), task shifting can indeed make a vital contribution to building sustainable, cost-effective and equitable health care systems. Without it, task shifting runs the risk of being yet another unsuccessful health sector reform initiative.