sible, and the amount of funding necessary to bring the workforce to full capacity is relatively minimal. The low per-patient cost of training compared with the cost of the drugs and other components of scale-up suggests that serious, well-planned investments in health worker training would be an extremely cost-effective move.

On the other hand, 10,000 people still represent only about 10 percent of the total number of Zambians currently in need of ART, and many more infected but currently immunocompetent Zambians will join these ranks over the next decade. Providing full ARV coverage for the entire clinical population in need, as it stands now (i.e., about 100,000 people, rising to about 330,000 in 5 years, but also assuming a 20 percent mortality rate), would marginally require an additional 130 FTE nurses and physicians in the first year and 429 by the fifth year, and 316 laboratory technicians in the first year and more than a 1,000 by the fifth year. And these estimates do not even begin to address additional voluntary counseling and testing (VCT) staffing needs. Clearly, the human workforce needs for full coverage are immense.

Throughout sub-Saharan Africa in particular, the reality of the human resource situation is sobering, as these accounts and a wealth of qualitative reports attest (Kober and Van Damme, 2004). Recent data related to the overall health-sector human resource crisis in Africa and collected for the U.S. Agency for International Development (USAID) reveal that newly constructed health facility structures, including clinics and hospitals, remain unstaffed or understaffed throughout sub-Saharan Africa, as general efforts to expand the network of such facilities have greatly outpaced efforts to build human resource capacity. For example, despite vigorous efforts by the government of Mali to expand the number of its community health centers to 533, 43 percent of these centers were not functioning as of January 2001, with the remainder not operating because of a shortage of personnel to staff them (Lynch and Diallo, 2001; USAID, 2003). As it takes 3 to 4 years to train and deploy nurses and 5 or more years to train and deploy physicians, it is clear that without sufficient and aggressive training initiatives, this gap between physical infrastructure and human resource capacity will continue to widen.

Given the desperate and growing demand for health workers and the losses of trained workers to better jobs in more well-to-do countries, many African nations have reportedly been encouraged to adopt human resource policies that lead to the deliberate overproduction of health workers to fill the growing gaps in human resource capacity. Filling these gaps is not a simple task, however, as the African health sector’s human resource crisis is multidimensional and involves a complex set of underlying upstream and more-proximal causal factors (Puku, 2002; Narasimhan et al., 2004; Schwab, 2001). The problem encompasses not just the scarcity of well-



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