Kamis, 09 Desember 2010


 Task-shifting concept has been applied for many aspects in our life. It is not a new concept to be introduced in medical field but has been used for hundreds years. For the introduction, I would like to use one simple example in explaining about task-shifting. Basically, family consists of father, mother and children. Previously, the role of father is working to earn money or at least to get some food such as fish, chicken or rice, depending on the occupation. The role of mother is take care and looks after children for their needs as well as for her husband. These jobs include cooking and washing. Nowadays, women have dual functions. They do not only act as wife but do they have their own occupation outside their lovely home. The increase in workload has forced a lot of family to hire servant. This servant helps this family in term of cooking, washing, and look after children while parents working. The example mentioned above explained about task shifting.
     In relation to medical field, task-shifting is very important nowadays. Why it is important? This is because of the lack of human resource as a doctor. The world population is growing fast. The growing of population has expanded world population because the advance health care and technologies, we are able to increase life expectancy. This does not mean that the quality of life has been increased at maximum level. The increased in life expectancy has become other burden to health care facilities because of the increase in number of people with chronic diseases such as hypertension and cancer. At the same time, there is a serious shortage of medical doctor in many parts of the world. In Malawi for example, there is around one doctor for every 100 000 population.
      The phenomenon above has forced us to find other solution in providing adequate medical care to the patients as well as increase in accessibility of the patient to health care facilities and services. In Malawi for example, Government officials had determined a problem related to antiretroviral drugs prescription. This had led to change in the Nurses and Midwives Practice Act and Pharmacy, Medicines and Poisons Act that allow nurse to prescribe drugs for antiretroviral therapy. Other examples include the training of cadre. This task-shifting is not only occurs in low or middle income countries, but it also happen in developed countries. Sweden, United Kingdom and Canada have given authorities to nurse to prescribe medication.  Cadre is important because they can be accessed by population easily. Task-shifting from doctor to cadre could give some benefits if training is sufficient. If sufficient training of cadre is given, we can probably control factors that can lead to in-effectives and in-efficient care by cadres such as irrational drug use. The presence of cadres can be formal or informal. Ethiopia has established a new system related to new cadres creation known as Health extension Worker. The aim of this new system is to establish appropriate legal basis for new cadres so that it can be integrated into civil service system and the existing delivery and regulatory system.  

    In conclusion, task-shifting phenomenon must be evaluated carefully because it can either give a lot of benefits or simply reduce the effectiveness and efficiency of care delivery.

References:1. World Health Organization, 2008. Task Shifting, Global Recommendation and Guidelines.

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