Global health leaders, national health ministers, and HIV/AIDS experts convened in Addis Ababa, Ethiopia on January 8–10, 2008, for the first International Conference on Task Shifting, to discuss the shortage of global health workers.  The conference, hosted by the Ethiopian government along with the World Health Organization (WHO), the United States President’s Emergency Plan for AIDS Relief (PEPFAR), and the Joint United Nations Programme on HIV/AIDS (UNAIDS), discussed the problems associated with global health worker shortages, introduced a plan to respond to the shortages, and laid out guidelines for this new plan.

A shortage of health workers is reaching widespread proportions worldwide with 57 countries largely affected, but is a major problem in sub-Saharan Africa and Asia where it is seen as crippling the efforts to combat HIV.  The shortage is due to a number of factors including the flow of medical personnel who are trained in poorer countries but then move to wealthier countries and HIV status among health workers.¹  The WHO estimates that 4 million more health workers are needed globally, and it can take anywhere from three to eight years to train nurses, midwives, and doctors.²  To help address the shortage, the WHO introduced a plan called “Treat, Train, Retain.”  This plan stresses treatment and HIV prevention among health workers, training and expanding the health workforce, and developing strategies to retain workers. 

The conference focused on task shifting, the training of community health workers (CHW), personnel who already have limited medical training, to perform less specialized tasks. CHWs can be trained, for example, to counsel those living with HIV, take blood samples, and forward those blood samples to technicians.³ As such, task shifting frees nurses, midwives, and doctors to perform more specialized work.  Another major benefit of task shifting is that it can take as little as a few months to a year to train a CHWs for these new roles. 

Dr. Anders Nordström, WHO Assistant Director General, Health Systems and Services explained, “Task shifting not only addresses the two interlinked emergencies of the health worker crisis and the HIV/AIDS pandemic, but also offers long-term potential for strengthening health systems in a way that is consistent with the current renaissance in primary healthcare services.”⁴ 

The WHO, however, acknowledges concerns about the potential for inappropriate implementation of this strategy.  It stresses that “adequate checks and balances” must be implemented in the form of health legislation and administrative regulation that will enable and regulate task shifting.⁵  To avoid decreases in the quality of care, the WHO created guidelines and recommendations on task shifting for countries that want to adopt the task shifting strategy, “Task Shifting: Global Recommendations and Guidelines.”  Recommendations cover such topics as how to adopt task shifting to ensuring the quality of care are provided.⁶

At the conclusion of the conference the attendees endorsed the “Addis Ababa Declaration on Task Shifting.”  The declaration recognizes the global health worker shortage and calls on countries to commit to solving the problem while implementing the WHO’s guidelines and recommendations.

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