Many hands make healthcare more efficient

The world is running a deficit of more than 4 million healthcare workers, but a proposed new shift in healthcare delivery may alleviate the shortage and bring new players to the field.

An article in the 13 December edition of the New England Journal of Medicine, Rapid Expansion of the Health Workforce in Response to the HIV Epidemic, introduces the World Health Organisation's battle plan to combat the shortage and revolutionise the way we think of healthcare.

The plan, called Treat, Train, Retain, aims to treat and prevent HIV among healthcare workers, train newcomers to facilitate "task shifting", and attempt to retain existing workers.

In Swaziland for example, a 2006 WHO report found that the public health sector has been crippled by staff shortages: 44 percent of posts for physicians, 19 percent of posts for nurses and 17 percent of nursing assistant posts are unfilled.

The authors argue that the plan's second focus - training - presents the most challenging imperative to expanding the healthcare workforce, while in task shifting duties like administering treatment are moved to less specialised healthcare workers.

Task shifting has been implemented in both low- and high-income settings with positive results. The Democratic Republic of the Congo introduced the practice in the 1970s and '80s in response to a shortage of fully trained healthcare workers. Studies found that doctors could delegate standardised tasks to auxiliary workers without reducing the quality of care.

In recent years, American and Australian nurses have increasingly taken on medical interventions previously handled by doctors, with studies showing an enhanced quality of care with reduced costs.

Clinical officers or medical assistants are already crucial to administering HIV treatment in Kenya, Ethiopia and Malawi, while Zambia is said to be moving in the same direction.

But the WHO's new model of healthcare moves beyond medical personnel like nurses and clinicians to include communities, an approach already practiced in countries like South Africa, Zambia, India and Lesotho.

However, the authors caution that a shift to innovative healthcare will need to be accompanied by a shift in mindset, and that the new systems will not offer a quick fix: training and credential systems will have to be developed, as will standardised protocols, including simplified drug regimens.

Adopting these new models will involve political and financial commitments by governments, donors and international organisations.

The Guidelines for Treat, Train, Retain will be launched at the first-ever global conference on task shifting, to be held in Addis Ababa, Ethiopia, in mid-January 2008.

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