Task shifting for antiretroviral treatment delivery in sub-Saharan Africa: not a panacea.

Task shifting should not be viewed as a panacea for the human-resources challenges facing sub-Saharan Africa. Rather, it must be part of an overall strategy that includes measures to increase, retain, and sustain health staff . In health care, the term “task shifting” generally refers to a process of delegation of tasks to health workers with lower qualifi cations. It may include task shifting between diff erent groups of professional workers or from professional to lay health workers. This concept is not new in public health. Task shifting is common in high-income countries, examples include nurse practitioners in the USA, nurse clinicians in Sweden, and expert patients for diabetes care. In several countries in sub-Saharan Africa, specifi c cadres of non-physician health workers have been created to do clinical tasks in places where physicians are scarce, such as in rural areas. Besides these non-physician clinicians, well known examples of the use of lay workers include the community health worker and the community-based volunteer for giving guardian-based directly observed treatment, short course (DOTS), for tuberculosis.