Task Sharing in Tanzania: The Expanded Role of Nurses in HIV/AIDS Care
By Kathryn Utan and Ronald Nakaka, American International Health Alliance
Mkuranga is one of six districts along the coast of the Indian Ocean that form Tanzania’s Pwani Region just south of Dar es Salaam,. About 190,000 people live in the 15 wards and 101 villages that make up the diminutive district.
Despite Mkuranga’s small size, the clinic providing HIV/AIDS-related services at the local district hospital is busy. An average of 40 patients seek treatment there each day, according to Mwanamshamu Jangama, an enrolled nurse who graduated with a certificate in nursing and midwifery from Mkomaindo School of Nursing and Midwifery in 2003.
When Jangama began working at the hospital, her duties focused largely on maternal, neonatal, and child health services. She started working in the HIV/AIDS clinic in 2007.
“It’s a one-stop center for comprehensive HIV services ranging from counseling and testing and provision of antiretroviral therapy (ART) to screening for TB and other opportunistic infections and adherence support,” Ms. Jangama explains.
She admits that due to severe understaffing, she and the other nurses have long had to take on these and other critical duties even though they were beyond their scope of practice as enrolled nurses. Otherwise, patients would not have continued access to the HIV care and treatment services they needed.
In early 2016, Tanzania formalized task sharing through an official policy coupled with a number of interventions to support the reallocation of specific tasks among health workers at varying qualification levels. This policy was enacted to address Tanzania’s severe shortage of human resources for health, particularly in rural areas.
“Task sharing is a systematic process in which specific clinical tasks normally performed solely by health personnel with extensive qualifications are shared with health personnel that have lower qualifications, less specialization, or limited scopes of training,” explains Lena M. Mfalila, Registrar of the Tanzania Nursing and Midwifery Council (TNMC).
“This approach involves the rational redistribution of tasks among health workforce teams, and is one method of strengthening and expanding the health workforce to rapidly increase access to health services,” Mfalila continues, noting that task sharing is helping Tanzania more efficiently use its limited pool of available human resources for health.
Task sharing is a critical mechanism helping Tanzania achieve the UNAIDS 90-90-90 targets of getting 90% of all of people living with HIV aware of their status, 90% of those diagnosed on sustained ARV treatment, and 90% of those on treatment maintaining durable viral suppression by 2020. It also supports the goals of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to achieve an AIDS-free generation.
Through the Tanzania Nursing Initiative (TNI), the American International Health Alliance (AIHA) has been supporting advocacy efforts to develop a robust and comprehensive task sharing policy in Tanzania since 2011. Now that the policy is operational, AIHA continues to work with the Ministry of Health, TNMC, and national leadership of the country’s nursing and social work cadres to effectively implement the new guidelines within these critical segments of the health and social services workforce.
Stressing that task sharing underscores the expanded role of the nursing and midwifery professions in Tanzania’s health system. Mfalila says that the policy can only be effectively and safely implemented if there is a system that regulates those functions.
With that in mind, AIHA is working with the ministry to roll out revised scopes of practice and implement continuous professional development and supportive supervision and mentorship programs for nurses and social workers.
At the Mkuranga HIV/AIDS Clinic, Jangama says she is confident in her ability to provide quality clinical services for people living with HIV thanks to the in-service training she has received in subjects such as TB, HIV, family planning, and cervical cancer.
“I now perform other tasks crucial for the management of HIV, including viral load monitoring, screening for opportunistic infections, and adherence to ART,” she reports, noting that she provides enhanced counseling for patients with high viral load and prescribes new medication when it’s necessary to change treatment regimens to achieve better patient outcomes.
Jangama underscores the importance of providing support by way of ongoing training, mentorship, and professional development for enrolled nurses and other care providers with expanded roles. She says it’s also critical to address the barriers that make their working environment difficult, andto keep them motivated.
Moving forward, AIHA will support professional development and regulation of healthcare workers as a way to ensure quality of care. Other priorities will be to rapidly address any challenges that emerge during the process of operationalizing the expanded scope of practice for nurses and social workers, as well as to find strategic ways to motivate these frontline health workers for the additional duties they are being asked to take on.
AIHA’s national-level work to strengthen Tanzania’s nursing and social work cadres is supported by the American people with funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Centers for Disease Control and Prevention (CDC), Tanzania. Both projects are implemented through AIHA’s HIV/AIDS Twinning Center Program, which is funded through a cooperative agreement with the US Department of Health and Human Services, Health Resources and Services Administration (HRSA).