age number of minutes that an ARV patient spends each year with a doctor—can help inform these discussions. Third, there are millions of people currently infected with HIV who will still not be clinically eligible for ART in 2008, and so issues of sustainability beyond that year should not be ignored.

Ultimately, however, the results presented here should serve as a starting point for detailed country-level work. It is there that the best data and understanding of local circumstances lie. The exercise of quantifying human resource needs by national stakeholders can provide important information before a program expands.13

Most important, it can help to inform policy measures that aim to address the human resource constraint. Potential solutions have been discussed in detail elsewhere.14 They may be pursued on multiple levels simultaneously: within the HIV/AIDS sector, within the health system more broadly, at the national level, or internationally. No single solution will offer a magic bullet to the human resource challenge; countries will need to adopt multipronged strategies to fit local circumstances. But taken together they can help contribute to a more successful program expansion.

REFERENCES

Aitken JM, Kemp J. 2003. HIV/AIDS, Equity and Health Sector Personnel in Southern Africa. Equinet Discussion Paper Number 12. [Online]. Available: http://www.equinetafrica.org/Resources/downloads/discussionpaper12.pdf [accessed August 24, 2004].


Huddart J, Lyons JV, Furth R. 2004. The Zambia HIV/AIDS Workforce Study: Preparing for Scale-up. [Online]. Available: http://www.qaproject.org/pubs/PDFs/ORMZambiaWorkforcel.pdf [accessed September 7, 2004].


Kombe G, Smith O. 2004. The Costs of HIV/AIDS Services within the Basic Health Care Package in Zambia. Unpublished.

Kurowski C, Wyss K, Abdulla S, Yemadji N, Mills A. 2003. Human Resource for Health: Requirements and Availability in the Context of Scaling Up Priority Interventions in Low Income Countries: Case Studies from Tanzania and Chad. London: Health Policy Unit, London School of Hygiene and Tropical Medicine.

13  

Country-level work can also better focus on the important issue of geography, which has not been addressed here. There is a strong urban bias to health sector human resource availability in low-resource countries, and this will make program expansion in rural areas even more challenging.

14  

See, for example, Aitken and Kemp (2003), USAID (2003), and Picazo (2003). The PEPFAR plan itself also discusses possible approaches to addressing human resource shortages. See Office of the United States Global AIDS Coordinator (2004).



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