Task sharing and task shifting: optimizing the primary health care workforce for improved delivery of noncommunicable disease services in Kenya

Integration of noncommunicable disease (NCD) care into primary health care (PHC) is crucial in addressing the NCD burden: this could improve health promotion and access to early NCD diagnosis and facilitate continuous management of NCDs at the population level. Successful NCD integration requires both investment in the health system and refocusing of PHC from an infectious disease emphasis to a system approach inclusive of NCD care. Strengthening the health workforce (HWF) is key in reorganizing the PHC system: availability and adequate capacity and distribution of health workers are crucial. Task sharing and task shifting (TSS) is an effective intervention to address HWF challenges: sharing clinical tasks with non-physician health workers (NPHWs) such as nurses and community health workers (CHWs) or shifting some tasks to them could help strengthen HWF to accommodate NCD care at the PHC level. An enabling legal and regulatory framework and adequate training of NPHWs are required to support TSS: the key enablers for successful TSS are training and on-the-job support for NPHWs. The barriers include the lack of a legal and regulatory framework for the new roles NPHWs assume such as prescribing medicines and other health system responsibilities.