Abstract：
The global critical shortage of health workers prevents expansion of healthcare services and universal health coverage. Like most countries in sub-Saharan Africa, Kenya\'s healthcare workforce density of 13.8 health workers per 10,000 population falls below the World Health Organization (WHO) recommendation of at least 44.5 doctors, nurses, and midwives per 10,000 population. In response to the health worker shortage, the WHO recommends task sharing, a strategy that can increase access to quality health services. To improve the utilization of human and financial health resources in Kenya for HIV and other essential health services, the Kenya Ministry of Health (MOH) in collaboration with various institutions developed national task sharing policy and guidelines (TSP). To advance task sharing, this article describes the process of developing, adopting, and implementing the Kenya TSP.
The development and approval of Kenya\'s TSP occurred from February 2015 to May 2017. The U.S. Centers for Disease Control and Prevention (CDC) allocated funding to Emory University through the United States President\'s Emergency Plan for AIDS Relief (PEPFAR) Advancing Children\'s Treatment initiative. After obtaining support from leadership in Kenya\'s MOH and health professional institutions, the TSP team conducted a desk review of policies, guidelines, scopes of practice, task analyses, grey literature, and peer-reviewed research. Subsequently, a Policy Advisory Committee was established to guide the process and worked collaboratively to form technical working groups that arrived at consensus and drafted the policy. The collaborative, multidisciplinary process led to the identification of gaps in service delivery resulting from health workforce shortages. This facilitated the development of the Kenya TSP, which provides a general orientation of task sharing in Kenya. The guidelines list priority tasks for sharing by various cadres as informed by evidence, such as HIV testing and counseling tasks. The TSP documents were disseminated to all county healthcare facilities in Kenya, yet implementation was stopped by order of the judiciary in 2019 after a legal challenge from an association of medical laboratorians.
Task sharing may increase access to healthcare services in resource-limited settings. To advance task sharing, TSP and clinical practice could be harmonized, and necessary adjustments made to other policies that regulate practice (e.g., scopes of practice). Revisions to pre-service training curricula could be conducted to ensure health professionals have the requisite competencies to perform shared tasks. Monitoring and evaluation can help ensure that task sharing is implemented appropriately to ensure quality outcomes.
The development and approval of Kenya\'s TSP occurred from February 2015 to May 2017. The U.S. Centers for Disease Control and Prevention (CDC) allocated funding to Emory University through the United States President\'s Emergency Plan for AIDS Relief (PEPFAR) Advancing Children\'s Treatment initiative. After obtaining support from leadership in Kenya\'s MOH and health professional institutions, the TSP team conducted a desk review of policies, guidelines, scopes of practice, task analyses, grey literature, and peer-reviewed research. Subsequently, a Policy Advisory Committee was established to guide the process and worked collaboratively to form technical working groups that arrived at consensus and drafted the policy. The collaborative, multidisciplinary process led to the identification of gaps in service delivery resulting from health workforce shortages. This facilitated the development of the Kenya TSP, which provides a general orientation of task sharing in Kenya. The guidelines list priority tasks for sharing by various cadres as informed by evidence, such as HIV testing and counseling tasks. The TSP documents were disseminated to all county healthcare facilities in Kenya, yet implementation was stopped by order of the judiciary in 2019 after a legal challenge from an association of medical laboratorians.
Task sharing may increase access to healthcare services in resource-limited settings. To advance task sharing, TSP and clinical practice could be harmonized, and necessary adjustments made to other policies that regulate practice (e.g., scopes of practice). Revisions to pre-service training curricula could be conducted to ensure health professionals have the requisite competencies to perform shared tasks. Monitoring and evaluation can help ensure that task sharing is implemented appropriately to ensure quality outcomes.
摘要：
全球卫生工作者的严重短缺阻碍了医疗服务和全民健康覆盖的扩大。像撒哈拉以南非洲的大多数国家一样，肯尼亚的医疗劳动力密度为每10,000人中13.8名卫生工作者，低于世界卫生组织（WHO）建议的至少44.5名医生，护士,和助产士每一万人口。为了应对卫生工作者的短缺，世卫组织建议任务共享，可以增加获得优质卫生服务的战略。改善肯尼亚将人力和财力卫生资源用于艾滋病毒和其他基本卫生服务，肯尼亚卫生部（MOH）与各种机构合作制定了国家任务共享政策和准则（TSP）。要推进任务共享，本文介绍了开发的过程，采用,并实施肯尼亚TSP。
肯尼亚TSP的开发和批准发生在2015年2月至2017年5月。美国疾病控制和预防中心（CDC）通过美国总统的艾滋病紧急救援计划（PEPFAR）促进儿童治疗计划向埃默里大学分配资金。在获得肯尼亚卫生部和卫生专业机构的领导支持后，TSP小组对政策进行了案头审查，指导方针,实践范围，任务分析，灰色文学，和同行评审的研究。随后，成立了政策咨询委员会来指导这一进程，并合作组建了达成共识并起草政策的技术工作组。合作,多学科过程导致了由于卫生人力短缺而导致的服务提供差距的识别。这促进了肯尼亚TSP的发展，这为肯尼亚的任务共享提供了总体方向。指导原则列出了各种干部根据证据分享的优先任务，如艾滋病毒检测和咨询任务。TSP文件已分发给肯尼亚所有县医疗机构，然而，在来自医学实验室协会的法律挑战之后，2019年根据司法部门的命令停止了实施。
任务共享可以在资源有限的环境中增加对医疗保健服务的访问。要推进任务共享，TSP和临床实践可以协调，以及对规范实践的其他政策进行的必要调整(例如，实践范围)。可以对服务前培训课程进行修订，以确保卫生专业人员具有执行共同任务的必要能力。监测和评估可以帮助确保任务共享得到适当实施，以确保高质量的结果。
肯尼亚TSP的开发和批准发生在2015年2月至2017年5月。美国疾病控制和预防中心（CDC）通过美国总统的艾滋病紧急救援计划（PEPFAR）促进儿童治疗计划向埃默里大学分配资金。在获得肯尼亚卫生部和卫生专业机构的领导支持后，TSP小组对政策进行了案头审查，指导方针,实践范围，任务分析，灰色文学，和同行评审的研究。随后，成立了政策咨询委员会来指导这一进程，并合作组建了达成共识并起草政策的技术工作组。合作,多学科过程导致了由于卫生人力短缺而导致的服务提供差距的识别。这促进了肯尼亚TSP的发展，这为肯尼亚的任务共享提供了总体方向。指导原则列出了各种干部根据证据分享的优先任务，如艾滋病毒检测和咨询任务。TSP文件已分发给肯尼亚所有县医疗机构，然而，在来自医学实验室协会的法律挑战之后，2019年根据司法部门的命令停止了实施。
任务共享可以在资源有限的环境中增加对医疗保健服务的访问。要推进任务共享，TSP和临床实践可以协调，以及对规范实践的其他政策进行的必要调整(例如，实践范围)。可以对服务前培训课程进行修订，以确保卫生专业人员具有执行共同任务的必要能力。监测和评估可以帮助确保任务共享得到适当实施，以确保高质量的结果。
