The global recommendations and guidelines on task-shifting propose the adoption or expansion of a task-shifting approach as one method of strengthening and expanding the health workforce to rapidly increase access to HIV and other health services. Task-shifting involves the rational redistribution of tasks among health workforce teams. Specific tasks are reassigned from highly qualified health workers to those who possess less extensive training and fewer qualifications, as appropriate. The objective is to increased the efficiency of the available human resources for health.

Reorganization and decentralization of health services, according to a task-shifting approach, can help resolve the problems associated with health worker shortages, which are particularly acute in countries that possess a high HIV/AIDS prevalence rate. That said, task-shifting alone will not resolve the health workforce crisis. The recommendations and guidelines stress that task-shifting should be implemented alongside other strategies that are designed to increase the total number of health workers. Furthermore, even though task-shifting is considered to be an efficient approach, it is one that will require considerable resources, which should not substitute for other investments in human resources for health.

The recommendations and guidelines were developed over one year, through a process of country consultation, extensive evidence gathering (including specially-commissioned research to address knowledge gaps), and broad consultation among a wide range of experts and stakeholders. The outcome was the establishment of 22 recommendations that provide overall guidance to those countries that are considering adopting or extending a task-shifting approach. The recommendations and guidelines identify and define the key elements that must be adopted for the approach to be considered safe, efficient, effective, equitable, and sustainable. They cover the need for consultation, situation analysis, national endorsement, and the regulatory framework. Additionally, the recommendations and guidelines specify the quality assurance mechanisms, which include standardized training,
supportive supervision, and certification and assessment, all of which are necessary for ensuring quality care. Furthermore, they cover the elements that will need to be considered for the purpose of guaranteeing adequate resources for implementation and offering advice on the organization of clinical care services under a task-shifting approach.

Task-shifting is already being implemented, in various degrees, as a pragmatic response to health workforce shortages in a number of countries. There also exists extensive evidence from the literature that task-shifting has been adopted informally in response to human resource needs throughout history. The aforementioned recommendations and guidelines aim to promote a formal framework that can support task-shifting as a national strategy for organizing the health workforce. Countries that are currently implementing task-shifting, specifically to increase access to HIV services, have been documented in a series of observational studies for the purpose of adapting these recommendations and guidelines. (These country studies are available as part of the WHO-Commissioned Study on Task Shifting, which accompanies this document in electronic Annex a). While evidence of the success of task-shifting for the delivery of HIV services in a variety of settings is compelling, further research is necessary. Implementation must be accompanied by a rigorous evaluation study that can assess various forms of task-shifting.

The recommendations and guidelines on task-shifting have been developed in the context of efforts to rapidly increase access to HIV services, in order to make as much progress as possible towards the goal of universal access to HIV services by 2010. That said, the impact of task-shifting should not be restricted to HIV service delivery. The implications for other essential health services, and the potential for wider health systems strengthening, are recognized.