Scope of Practice/Task Shifting
The current shortage of health care professionals in many countries of the world has created a major migration of health professionals, generally from poorer to richer countries. According to the World Health Report 2006, several wealthy countries of the world rely heavily on physicians from other countries. The report describes the situation of New Zealand and Great Britain, where one third of the active physicians are from abroad, as well as the USA and Canada, whose physician workforces consist of nearly one quarter foreign physicians. On the other side, some African countries, such as South Africa, Ghana and Angola have lost 20 to 35 % of their physicians to emigration.This situation leaves some of the poorest countries of the world with nearly no physicians. While many wealthy countries have a physician to population ratio of 1 to 500, in Malawi, for instance, this ratio is 1 to 50.000. According to the WHO, a total of 57 countries, mostly in sub-Saharan Africa, but also including Bangladesh, India and Indonesia, face serious health workforce shortages.
Rich countries also experience shortage of health care professionals, especially of physicians, and often react by assigning physicians’ tasks to other health professionals. Prescribing rights may be given to pharmacists and endoscopies may be performed by nurses. In some cases, due to financial constraints, individuals are provided less comprehensive training and education than physicians require, but are still given professional titles that make it difficult to discern that they are not, in fact, fully trained physicians. Changing scope of practice manifests itself in a variety of ways among countries. In some instances, there is a trend towards autonomous performing of physicians’ tasks by other health personnel, while in other countries the trend is toward delegation with supervision by physicians. Regardless of what system is in place, the essential objective must be quality care for all patients.
In response to the worldwide health workforce shortage, the WHO has developed Global Recommendations and Guidelines on Task Shifting, which were approved by African health ministers in a conference in Addis Ababa in early 2008.
The Global Health Workforce Alliance – a partnership of national governments, civil society, international agencies, finance institutions, researchers, educators, and professional associations including the WMA - issued the Kampala Declaration and Agenda for Global Action on task shifting in March 2008. In anticipation of this declaration, the World Health Professions Alliance (http://www.whpa.org) together with the World Federation for Physical Therapy and the International Confederation of Midwifes developed 12 guiding principles for successful task shifting.
In March 2009, the World Medical Association invited medical leaders and leaders from other health professions to a seminar "Human resources for health & the future of health care" in Reykjavik, Iceland, to exchange information and share experiences on scope of practice and task shifting as a response to the health workforce crisis.
The WMA, together with the World Health Professions Alliance and the World Confederation of Physiotherapy, organised the First World Health Professions Conference on Regulation WHPCR in Geneva in May 2008. The conference explored the future of health care system regulation with a special focus on scope of practice, overlaps and conflict in responsibilities, and skills mix. A second conference on regulation WHPCR 2010 was organised on 18-19 February 2010 in Geneva.
WMA Current Policy & Action
- WMA Seminar „Human resources for health & the future of health care“, 8-9 March 2009, Reykjavik, final report
- Joint Health Professions Statement on Task Shifting - 28 February 2008
- Resolution on the Medical Workforce (under revision), October 1998
- Report of the First World Health Professions Conference on Regulation 2008
- WMA Resolution on Task Shifting from the Medical Profession, Delhi, October 2009
- See also the WMA pages on migration and retention
- Global Recommendations and Guidelines on Task Shifting including the Adis Ababa Declaration - 2008
- The Kampala Declaration and Agenda for Global Action
- The World Health Report – Working together for health. Geneva, World Health Organization, 2006
- Read more on the global shortage of health workers and its impact (WHO)