PHA-Exch> Task-shifting and the Alma-Ata vision

[Claudio Schuftan]

From: Charles Wiysonge Charles.Wiysonge at mrc.ac.za


Task-shifting to nurses and lay health workers may contribute to achieving
the Alma-Ata vision

Task-shifting from doctors to nurses and from health professionals to lay
providers may contribute to achieving the Alma-Ata vision of primary health
care for all. This is among the conclusions of the second in an eight paper
Series in the Alma-Ata Special Issue of The Lancet by SUPPORT researchers
from institutions in the UK, South Africa, Norway, Canada, Chile and
Argentina.

The authors note that while task shifting offers opportunities for expanding
primary health care coverage, effective and supportive supervision of
providers is also likely to be key to improving service delivery. In this
overview of reviews
<
http://www.thelancet.com/journals/lancet/article/PIIS0140673608614038/abstract>
 of health system interventions in primary health care in low-and
middle-income countries, the authors say that user fees reduce usage of both
essential and non-essential services and drugs, but that care must be taken
if removing such fees to ensure health workers receive adequate pay.
Alternative financing structures must also besought. The authors found that
financial incentives can be used to influence provider and patient
behaviours, but can have undesirable effects such as the adverse selection
of patients by providers.

The authors also found that quality improvement strategies, such as
educational outreach and guideline dissemination, can have important
effects, yet such strategies to integrate primary health-care services have
not yet been assessed adequately. They conclude that a range of governance,
financial, delivery and implementation strategies will be necessary to
improve the delivery and performance of primary health care and achieve the
Alma-Ata vision. They add that any action to improve primary health care
must be "accompanied by rigorous evaluations of the strategies that are
used".

SUPPORT http://www.support-collaboration.org/  is a cooperative partnership
between researchers and policy-makers, which aims to improve the use of
reliable research evidence in policy and management decisions on maternal
and child health in low- and middle-income countries.
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