Healers Abroad Americans Responding to the Human Resource Crisis in HIV/AIDS (2005) / Chapter Skim
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1 Introduction
1 Introduction
Pages 19-43
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From page 19... ...
Since the disease emerged, the dearth of health workers to treat and care for these HIV-infected individuals has reached crisis proportions. The few health professionals practicing in many of the countries highly impacted by HIV/AIDS -- workers often stressed, ill prepared, and scant in number -- must now cope with a staggering new burden of disease while at the same time acquiring the knowledge, skills, and technology to deliver lifelong antiretroviral drug regimens, HIV/AIDS clinical and palliative care, and prevention services.
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preventing 7 million new HIV infections; and (3) providing care to 10 million people infected with or affected by HIV/AIDS, including orphans and vulnerable children.
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Indigenous health professionals must be trained, supported, and retained if they are to be used to leverage and sustain the U.S. fiscal and human resource investment in services related to HIV/AIDS, including ART scale-up, as well as to other global health issues.
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global health professions service program Committee members and consultants were selected for their international experience in low- and middle-income countries, as well as their individual expertise in the following areas relevant to the committee's charge: clinical medical practice; nursing; nongovernmental organizations and partnering; social science, health education, and training programs; pharmacy, logistics, and informatics; laboratory services in resourceconstrained areas; administration and policy with regard to international health resources; epidemiology and operations research; academic health care; and faith-based organizations. A brief profile of each member and consultant can be found in Appendix H
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Around 2.8 billion people worldwide live on less than $2 a day, while well over a billion subsist on less than $1 a day. As a consequence, almost everything that residents of wealthy countries take for granted -- good nutrition, access to education, low rates of communicable disease, long life expectancies -- is the exception rather than the rule for these global neighbors, whose daily reality often is characterized by unsafe drinking water, lack of sanitation, illiteracy, periodic food shortages, epidemic diseases, and premature death.
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, contributed to the doubling of life expectancy in the United States over the last century. In a recent analysis of the global health care workforce, the Joint Learning Initiative -- a consortium of more than 100 health leaders -- argues that mobilizing and strengthening human resources will be central to combating health crises in some of the world's poorest countries and to building sustainable health systems in all countries (JLI, 2004)
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Proper prescription of and monitoring of compliance with antiretroviral drug regimens are essential if patients are to benefit and if the grave possibility of emerging drug resistance is to be reduced. People living with HIV infection also require access to a wide range of care -- from primary, secondary, and tertiary health care; to social services; to community-based support and home care.
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. The total global health workforce is currently estimated at more than 100 million -- a figure that includes 24 million recorded doctors, nurses, and midwives, plus another pool of uncounted informal, traditional, community, and allied workers (Chen et al., 2004)
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. In many countries, including those with high HIV prevalence, the inability to recruit and retain an effective, well-motivated, appropriately skilled workforce stems from a range of additional problems that include low pay, poor work conditions, and weak management.
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patients are coinfected with HIV. In KwaZulu Natal, South Africa, hospital admissions rose by 81 percent over 10 years, while adult TB ad missions (an indirect reflection of the HIV/AIDS burden)
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A study in a South African hospital investigating the potential for HIV transmission from needle sticks and other sharp-instrument injuries found that 41 percent of such injuries occurred among nurses and 38 percent among cleaners, although the latter comprised only 16 percent of total hospital personnel (de Villiers, 2000)
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. Low wages in the public sector can also drive workers into "dual practices," whereby public servants provide private services (Ferrinho et al., 2004; Vujicic et al., 2004)
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. South Africa and Malawi have used bonding or compulsory service regulations to shift their geographic distribution of health workers, although these methods have proven difficult to monitor and enforce (Chomitz et al., 1998; Hammer and Jack, 2002)
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A 10 percent increase in health worker density was correlated with a 2 percent decline in under-5 mortality.3 Achieving the above goals for health will therefore require concerted efforts to increase the total health workforce in developing countries. The Joint Learning Initiative estimates that sub-Saharan African countries must nearly triple their current health workforce by adding the equivalent of 1 million workers through retention, recruitment, and training if they are to come close to meeting these goals (Chen et al., 2004)
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. The Health Workforce Crisis in Africa4 The problem of insufficient human resources for health care is most acute in sub-Saharan Africa, which bears 25 percent of the world's burden of disease but houses only 1.3 percent of the world's health workforce.
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. A 2003 USAID report notes that only one-fourth of rural doctors in South Africa are South African nationals, with most of the remainder coming from other African countries, such as Zambia, Zimbabwe, and Congo (Kober and Van Damme, 2004)
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. oping countries of human resources in the health sector may mean that the capacity of the health system to deliver health care equitably is signif icantly compromised.
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. · In South Africa, the national HIV/AIDS treatment plan aims to create 12,000 new posts, yet 29,000 positions in the public health sector are currently unfilled.
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As the Joint Learning Initiative report states, "no country is an island in workforce development." The report further indicates that migratory flows produce benefits as well as harm, and blocking the movement of people violates human rights and is generally unenforceable. "[Therefore]
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reviews and provides evidence for the current human resource crisis in global health, outlines the challenges of confronting HIV/AIDS (and other global diseases) on the ground, and describes a range of national and international initiatives currently focused on global HIV/AIDS.
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It then provides detailed descriptions of six proposed programs of the Global Health Service, along with short- and long-term mechanisms for mobilizing, preparing, sending, managing, and compensating U.S. health professionals serving in the PEPFAR focus countries.
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Global Health Service Chapter 6 Looking Ahead report revisits the big picture of national health capacity development in resource-poor and other countries; value-added investments in achieving the PEPFAR goals; ethical issues in foreign workforce assistance; creative publicprivate partnerships and alliances under PEPFAR; and processes for monitoring, evaluation, and adjustment. REFERENCES Adano U, O'Neil M, Decima E, Kiarie W
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1999. Admission trends in a rural South African hospital during the early years of the HIV epidemic.
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2003. The Impact of HIV/AIDS on the Health Workforce in sub-Saharan Africa: The Issue of Human Resources: Support for Analysis and Research in Africa Project (SARA)
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2002. Report on Consultative Meeting on Improv ing Collaboration Between Health Professionals, Governments, and Other Stakeholders in Human Resources for Health Development.
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