Health worker task sharing improves access to HIV treatment in Tanzania

 {Photo credit: Flor Truchi/MSH}Anna Mzeru, Assistant Nursing Officer at Yombo Dispensary in Bagamoyo, Tanzania, shows facility data for HIV-positive patients, including those lost to follow-up and those currently on first- or second-line antiretroviral treatment.Photo credit: Flor Truchi/MSH

By Megan Montgomery

Days are long for Anna Mzeru.

A nurse at a health dispensary in the Bagamoyo region of Tanzania, she is one of only two medical staff at a facility that should have nine to be fully staffed. She and the other provider see as many as 120 patients per day, and attend an average of 15 deliveries per month. “We sometimes leave very late, but we can’t leave the patients here. They need to be seen,” she says.

The significant shortage of health workers at the clinic is common. Tanzania has a 56% vacancy rate across both public and private health care facilities. This makes it difficult to deliver quality services and achieve public health goals, particularly for HIV and AIDS prevention, detection, and treatment.

[A mother and her two children wait to be seen at Yombo Dispensary in Bagamoyo, Tanzania. The facility provides primary care services and has an HIV care and treatment clinic onsite.] {Photo credit: Megan Montgomery/MSH}A mother and her two children wait to be seen at Yombo Dispensary in Bagamoyo, Tanzania. The facility provides primary care services and has an HIV care and treatment clinic onsite.Photo credit: Megan Montgomery/MSH

Supported by the Centers for Disease Control and Prevention and funded by the US President’s Emergency Plan for Aids Relief (PEPFAR), MSH has partnered with the Tanzanian Ministry of Health, Community Development, Gender, Elderly, and Children to develop and implement a comprehensive human resources task-sharing plan. This initiative aims to strengthen Tanzania’s health system, with a focus on the availability of HIV and AIDS services, by making the existing health care workforce more efficient and effective while continuing to expand it.

[“I like this job because I want to help others,” says Anna Mzeru. With the NIMART training she received, Mzeru says her work performance and patient attendance rate have both improved.] {Photo credit: Megan Montgomery/MSH}“I like this job because I want to help others,” says Anna Mzeru. With the NIMART training she received, Mzeru says her work performance and patient attendance rate have both improved.Photo credit: Megan Montgomery/MSH

The idea is to train staff to handle activities that would normally be outside the scope of their duties to make more efficient use of human resources. Sharing tasks with junior staff can free up those with higher-level skills to handle more complicated cases. Task sharing also allows for better distribution of work across the facility so that patients receive more timely care.

As part of the program, Mzeru attended a 10-day Nurse Initiated Management of Antiretroviral Therapy (NIMART) training last year that included lectures, discussions, and practical sessions. While she previously had to refer patients to district facilities for HIV care — even though many could not afford transport — she can now perform all HIV services right in her office. This includes initiating and refilling antiretroviral therapy and adjusting a patient’s treatment regimen as necessary after viral load testing to see how they are responding to it.

MSH is also helping Tanzania develop e-learning modules to increase the task-sharing plan’s reach and sustainability.

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The MSH-led Tanzania Technical Support Services Project (TSSP), which is funded by the US Centers for Disease Control and Prevention, supports and strengthens Tanzania’s ministry of health and key public health institutions to achieve HIV epidemic control and sustain HIV-related health systems and services.