1 World Health Organization, Geneva Human Resources for Scaling Up HIV/AIDS Interventions Evidence...

1

World Health Organization, Geneva

Human Resources for Scaling Up

HIV/AIDS Interventions

Evidence and Information for Policy

Barbara Stilwell, Coordinator, Dept. of Human Resources for Health, Geneva

2


The size of the problem

Africa's Burden of the World's Diseases

25%

Africa's Share of the World's Health Workforce

1.3%

3


HRH challenges for achieving HIV/AIDS interventions

Inadequate number of HRH and inadequate distribution

-

400,000

800,000

1,200,000

1,600,000

People living with HIV/AIDS Number of HRH

Nu

mb

er o

f in

div

idu

als

France

Tanzania

4


HRH challenges for achieving HIV/AIDS interventions

Qualification of HRH Stigma attached to HIV/AIDS

Skill level of health workers in Chad

0%

10%

20%

30%

40%

50%

60%

no formalskills

nursing andmidwifery

skills

clinical skills,general

diagnosticskills

clinical skills,specialiseddiagnosis

skills

administrationand

management

technical skills

Perc

ent

“Stigma will follow me, and my brothers and sisters for the rest of our lives. Sometimes it even accompanies us into death” (South Africa, PLWA)

5


Trends in migration rates among health and other professionals in the UK

1

10

100

1000

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Year

Nu

mb

er

(th

ou

san

ds)

Total All professionals Physicians Nurses

Migration

Sources: General Medical Council, 2002; Nursing and midwifery council, 2002; Migration Research Unit, 2002

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Intention to migrate from Nigeria: Main reasons

28

44

28

0

10

20

30

40

50

Poor remuneration Slow opportunity forrapid promotion

Poor careerrecognition

% o

f re

spo

nd

ents

wh

o i

nte

nt

to m

igra

te

Source: MoH, 2003

7


Physicians per 100,000 inhabitants

0

20

40

60

80

100

Afr

ica

SE

Asi

a

Wes

tern

Pac

ific

Am

eric

as

Eas

tern

Med

iterr

anea

n

Eur

ope

% o

f co

untr

ies

in r

egio

n

< 50 50 - 149 150 - 299 300 +

Nurses-midwives per 100,000 inhabitants

0

20

40

60

80

100

SE

Asi

a

Afr

ica

Am

eric

as

Eas

tern

Med

iter

ran

ean

Wes

tern

Pac

ific

Eu

rop

e

< 50 50 - 199 200 - 499 500 +

Distribution of countries by stock of HRH, according to region

Source: WHO database on health personnel, late 1990s

Health workforce distribution

Source: HRH data base, WHO, 2000

8


Labour market

Percentage of doctors with dual employment

0

10

20

30

40

50

60M

oza

mbi

que

Zim

babw

e

Côte

d'Ivo

ire

Sri-L

anka

Jam

aic

a

Chad

Source: HRH 6 country study, WHO, 2003

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• Difficulty to plan the required number of staff in the ART care flow

• What skills should be taught to which level of staff?• Impact of HIV/AIDS on staffing - absenteeism due to

morbidity, mortality, time lost due to funeral attendance and caring for sick family members

HIV/AIDS specific HR issues countries are struggling with :

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HIV/AIDS and HRH models

• Community projects• Employer-based schemes• Public hospital PMTCT• Developing national systems of care

institutions from various sectors• National expansion programme based on PLWA input at clinic and community level • Research sites delivering care

Site visits (41)+

Country HR assessments

Gathering evidence and information to identify ART delivery systems and HRH inputs from:

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Adjusted service targets method for HRH requirements

Demographics

Incidence and prevalence of

diseases

Needs

Service Targets

Tasks

Time requirements

Productivity /efficiency gains

HRH requirements (FTEs)

Services Skills required

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The way forward with the highest level of political support• Short term

– Transfer of tasks to community members, including involvement of PLWA

– Combination of tasks: review all clinical/preventive tasks at all

levels for all programmes

– Emergency response resources - volunteers

– Short period training

– Develop stigma reduction strategies

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The way forward with the highest level of political support• Medium term

– Changes in legislation to maximize HRH use • Review regulations governing health providers’ diagnostic and

treatment authority

• New cadres of health care workers that can be trained quickly

• New HRH skill mix

– Policies addressing HRH retention problems

– Public /private partnerships

– Health worker substitution


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The way forward with the highest level of political support• Long term

– Strengthening capacity of health systems at regional and national level -

including HRH development plans and migration

– Building supportive infrastructures

– Increasing the stock of HRH (training)

– Review fiscal policies to overcome public sector employment constraints


1 World Health Organization, Geneva Human Resources for Scaling Up HIV/AIDS Interventions Evidence...

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