‘Re-Engineering the Workforce to Meet Service Needs’: Exploring ‘Task-Shifting’ in South Africa in the Context of Hiv/Aids and Antiretroviral Therapy

ABSTRACT

This article explores the major trends in the South African health workforce in the context of HIV/AIDS and analyses their potential impact on the professional work and status of nurses and doctors. The Human Resources for Health Strategy for the Health Sector 2012/13-2016/17 document, in addition to a wide range of secondary material, is used to depict the shifts that have taken place in the SA health workforce as a response to the unmet health needs and demands emanating from HIV/AIDS. Such a response is particularly challenging in the context of limited-resource settings and inadequate public healthcare services. Therefore, there has been a need to come up with inventive ideas to mobilise all available resources to curtail the spread of the epidemic as well as to cope with the provision of ART to large numbers of people as quickly as possible. Adopting a critical-analytical approach, this article draws attention to three such ideas: task-shifting, the training of new mid-level workers, and the use of members from the community in a variety of roles as ‘community health workers’. Although these ideas are not new, they acquire acute poignancy in the context of HIV/AIDS in South Africa today. They also provide an interesting case study through which to interrogate arguments advanced in the sociology of the professions about ‘medical dominance’, ‘occupational monopoly’, ‘laymanisation’ and the potential challenge to medical authority and power that may have occurred alongside shifts in professional boundaries.

Keywords:

• HIV/AIDS
• task-shifting
• mid-level health workers
• community health workers
• professional boundaries