Furthermore, while HIV/AIDS is a devastating epidemic, it is not the only source of morbidity and mortality faced by the PEPFAR countries. Drawing personnel into ARV provision will mean that fewer workers are available to address other priority health problems. In short, it is possible that in many settings the human resource constraint will be a greater obstacle to program expansion than the financial constraint.

The purpose of this chapter is to provide illustrative estimates of the human resource requirements for achieving the PEPFAR goal of treating 2 million patients with ARVs.2 There is a rapidly growing literature on the impact of HIV/AIDS on human resources for health, touching on both the complex nature of the problem as well as possible solutions (Aitken and Kemp, 2003; USAID, 2003). The objective here is more narrowly defined: to make a first step toward quantifying the human resource needs for PEPFAR. This exercise can help answer questions such as: How do needs compare with existing capacity? Which countries face the greatest challenge? Which categories of health personnel are in shortest supply? The analysis will also help point the way to potential solutions, although these are not discussed in detail. These issues are most appropriately addressed at the country level, where better data are available and policies can be tailored to local circumstances. The broad approach and illustrative estimates presented here will ideally serve as a starting point for more detailed country-specific work.

In the discussion that follows, the term “human resource requirements” refers to the number of people required to deliver ART-related health services. Making sure that they have the appropriate training to do so is another key aspect of the human capacity development issue that is not addressed here. More broadly still, there is a whole range of critical institutional components to a well functioning health care system—including governance structures, financing arrangements, logistics and information systems, and other issues—that are beyond the scope of this study. The difficulties that many public health systems have experienced in addressing less expensive and less labor-intensive health problems than ART should serve as a reminder that no amount of resources per se, whether financial or human, can guarantee program success in the all-too-frequent absence of these broader “architectural” health system inputs.


Human resource needs for other ART initiatives, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, would be additional to those presented here. Nor does this paper constitute a comprehensive estimate of all PEPFAR human resource needs: VCT and OI services are included, but the treatment of sexually transmitted infections, prevention of mother-to-child transmission, and other services are not.

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