There are many reasons why the United States Government (USG) should invest in understanding the magnitude and complexity of HR issues in the 15 focus countries. First, these countries account for more than 50 percent of all global infections and nearly 75 percent of all HIV infections in Sub-Saharan Africa. It is estimated that without a significantly expanded response to the epidemic, more people will become infected in the next few years. Second, there is compelling evidence from published and unpublished reports that the 15 countries studied have a critical shortage of human resource stock. The current ratio of key health workers to population in each country is not encouraging. According to the latest available information, 7 of the 15 countries have a ratio less than one doctor to 5,000 and 6 of them have a ratio below one nurse to 2,000 inhabitants as shown in Table C-1. These ratios are well below the WHO recommended minimum standard of one doctor per 5,000 inhabitants and one nurse per 500 population. Third, understanding the number of available health care workers, their skill mix, training needs, and the distribution of such personnel is essential in planning a USG response to fill in HR gaps through allocation of appropriate resources. This information can also be of critical value to countries themselves in developing appropriate strategies to address the HR problems to improve their overall health systems. As the President Emergency Plan for AIDS Relief (PEPFAR) countries begin to scale up HIV/AIDS activities, increased attention should focus on identifying and addressing these HR constraints.

The objective of this paper is to provide broad estimates on the quantity and mix of human resources needed to deliver full HIV/AIDS services in PEPFAR countries. The paper is organized in the following manner. First, the paper presents the methodological approach used in the analysis. Second, it presents specific findings on the current and projected future HR stocks, projects the HR needs to provide full HIV/AIDS services² under PEPFAR targets, and identifies the gaps. Finally, it recommends strategies to fill these HR gaps, discusses policy implications and the way forward.

A comprehensive desktop review of published and unpublished documents was conducted to obtain information on human resources in the 15