IFGH 2012: Task Sharing: The Human Resource Cost of HIV Scale-up in Zambia

January 30, 2012


Authors:Walsh A.1, Simbaya J.3, Dicker P.1, Brugha R.1, 2

Author Affiliations:1Royal College of Surgeons in Ireland, 2London School of Hygiene and Tropical Medicine, 3Institute of Economic and Social Research, University of Zambia

Option 1– Scientific / Empirical Research Findings Presented as – Poster


The benefits of task shifting as a strategy to compensate for health worker shortages, has been widely promoted. This study uses trends in HIV and non-HIV service workloads in Zambia to illustrate ‘task sharing’, where staff take on additional clinical responsibilities.


All health clinics and hospitals in two urban and one rural district were surveyed (n=41). Facility records were reviewed and analysed in 2009, quantifying HIV and non-HIV service episodes and patient attendances between 2005 and 2007.


  • Staff densities were much lower than the recommended WHO minimum workforce density needed to provide essential health services.
  • The ratios of antenatal care and family planning registrants to nurses/midwives were highest at baseline and increased in rural facilities.
  • HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts.
  • By 2007, staff designated as ART and PMTCT workers made up a higher proportion of frontline service providers than they had in 2005, while numbers of staff at the health facilities were unchanged.


Discussion/conclusions/ implications:

Over time, as standardised protocols and guidelines were introduced, increasing ratios of total clinical staff numbers to those delivering ART and PMTCT can be attributed to HIV and AIDS services being increasingly mainstreamed into normal facility staff workloads. This was a positive development from the perspective of availability of services and the institutionalisation of HIV and AIDS control at facility level. However, achievements in scaling-up HIV/AIDS services were on the back of sustained non-HIV workload levels, increasing HIV workload and stagnant health worker numbers. Task sharing rather than task shifting is occurring in Zambia, where staff take on additional tasks without losing their existing responsibilities.



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