The development of task sharing policy and guidelines in Kenya.

BACKGROUND: The global critical shortage of health workers prevents expansion of healthcare services and universal health coverage. Like most countries in sub-Saharan Africa, Kenya's healthcare workforce density of 13.8 health workers per 10,000 population falls below the World Health Organization (WHO) recommendation of at least 44.5 doctors, nurses, and midwives per 10,000 population. In response to the health worker shortage, the WHO recommends task sharing, a strategy that can increase access to quality health services. To improve the utilization of human and financial health resources in Kenya for HIV and other essential health services, the Kenya Ministry of Health (MOH) in collaboration with various institutions developed national task sharing policy and guidelines (TSP). To advance task sharing, this article describes the process of developing, adopting, and implementing the Kenya TSP. CASE PRESENTATION: The development and approval of Kenya's TSP occurred from February 2015 to May 2017. The U.S. Centers for Disease Control and Prevention (CDC) allocated funding to Emory University through the United States President's Emergency Plan for AIDS Relief (PEPFAR) Advancing Children's Treatment initiative. After obtaining support from leadership in Kenya's MOH and health professional institutions, the TSP team conducted a desk review of policies, guidelines, scopes of practice, task analyses, grey literature, and peer-reviewed research. Subsequently, a Policy Advisory Committee was established to guide the process and worked collaboratively to form technical working groups that arrived at consensus and drafted the policy. The collaborative, multidisciplinary process led to the identification of gaps in service delivery resulting from health workforce shortages. This facilitated the development of the Kenya TSP, which provides a general orientation of task sharing in Kenya. The guidelines list priority tasks for sharing by various cadres as informed by evidence, such as HIV testing and counseling tasks. The TSP documents were disseminated to all county healthcare facilities in Kenya, yet implementation was stopped by order of the judiciary in 2019 after a legal challenge from an association of medical laboratorians. CONCLUSIONS: Task sharing may increase access to healthcare services in resource-limited settings. To advance task sharing, TSP and clinical practice could be harmonized, and necessary adjustments made to other policies that regulate practice (e.g., scopes of practice). Revisions to pre-service training curricula could be conducted to ensure health professionals have the requisite competencies to perform shared tasks. Monitoring and evaluation can help ensure that task sharing is implemented appropriately to ensure quality outcomes.

Explication of a Behavioral Health-Primary Care Integration Learning Collaborative and Its Quality Improvement Implications.

In an effort to tackle fragmented care in the US healthcare delivery system, we explored the use of learning collaborative (LC) to advance integration of behavioral health and primary care as one of the potential solutions to a holistic approach to the delivery of quality healthcare to individuals with physical and mental illness. How a diverse group of primary care and behavioral health providers formed a Community of Practice (CoP) with a common purpose and shared vision to advance integrated care using a LC approach is described. An account of their learning experience, key components of their quality improvement, practice changes, clinical processes, and improved outcomes are explained. This paper aims at describing the history, creative design, processes, roles of the CoP and impact of the LC on the advancement of integrated care practice and quality improvements for further exploration and replications.

An Examination of Perceptions in Integrated Care Practice.

Successful integration of behavioral health and primary care services is informed by perceptions of its usefulness to the consumer. An examination of provider, staff and patient perceptions was conducted across five integrated care sites in order to describe and examine perceptions and level of satisfaction with integrated care. A quantitative study was conducted with data collected through surveys administered to 51 patients, 27 support staff, and 11 providers in integrated care settings. Survey responses revealed high levels of satisfaction with integration of primary and behavioral health services. Integrated care can be enhanced by addressing provider competency and confidence concerns through continued education, increased collaboration and utilization of diagnostic tools. This analysis provides evidence to support that successful integration increases access to mental healthcare, which is instrumental in reduction of the mental health treatment gap by scaling up services for mental and substance use disorders among individuals with chronic medical conditions.