However, because these roles have evolved informally,
usually at the facility or program level,
there's frequently an absence of corresponding laws, regulations, or
official policies to support the newly acquired duties and responsibilities.
Although global normative bodies have endorsed expanded scopes of practice for
non-physicians, including community health workers, and
have developed specific guidance supporting their implementation,
policy challenges arise when official regulations regarding task
shifting lag behind program efforts to scale up a health initiative.
This asymmetric state of affairs is especially notable within HIV care and
treatment services delivered in maternal and child health settings.
For example, until recently PMPCT Programs consisted of anti-retroviral
regimens that focused on preventing HIV transmission to the newborn.
Recently this protocol has been replaced with a more comprehensive regimen that
incorporates maternal HIV care and HIV prevention for the infant.
Current WHO guidelines regarding PMTCT services recommend the provision
of lifelong ART to all pregnant and breastfeeding women infected with HIV,
regardless of their immune status or clinical stage of the disease.
This newer focus on the mother, also referred to as option B+ is based on
the latest scientific understanding of HIV transmission, and was introduced as
a means to simplify the diagnosis and treatment of the disease among pregnant
women, while simultaneously reducing mother-to-child viral transmission.
While this latest protocol has the potential to simplify the work of
healthcare providers, by reducing diagnostic complexity and
promoting service integration between PMTCT and ART, it has also
increased task shifted responsibilities among lid, mid-level providers.
A number of ministries of health have adopted option B+ services in
their maternal and child health clinics, and have informally accepted task
shifted practices, even though their national laws and
regulatory policies restrict diagnosing and prescribing ART to medical doctors.
In some instances, these restrictions are supported by the medical
profession councils, who view task shifting as an erosion of their authority.
In other instances, pharmacy boards responsible for
determining which drugs can be prescribed by which health provider,
are the barrier to developing and advancing national task shifted policies.
Additionally, there are situations of unintentional oversight,
where lack of awareness and
communication between national HIV programs and the respective policy and
legal governmental units have resulted in an absence of updated policies,
making health workers vulnerable to legal, professional, and ethical violations.