Africa: HIV and AIDS

The AIDS crisis is one of the most important factors driving the human resources crisis in Africa. UNAIDS's 2005 update reports that 25.8 million adults are living with HIV in sub-Saharan Africa, with 3.2 million adults and children infected with HIV in 2005. With sub-Saharan Africa the hardest hit by HIV and AIDS, the impact of the crisis is felt at all levels of society.

Impact

The impact of HIV/AIDS on health systems and the health workforce in sub-Saharan Africa highlights how health systems may lose up to 20 per cent of their employees over the next several years. The demographic make up of the health workforce population is also a significant element when considering the impacts of HIV and AIDS. For instance, the demographic profile of health workers in Botswana is that female health workers outnumber male health workers by almost two to one. The authors argue that human resource plans will need to incorporate staff losses based on demographic, gender and socioeconomic factors.

Specific health workforce challenges of HIV and AIDS in sub-Saharan Africa include: new demands of knowledge and skills, increased burden of work in an already stretched health system, increased safety risks and increased rates of HIV among health workers. The authors argue that a comprehensive and coordinated approach, across several sectors of government, is needed to tackle these multiple issues.

The impact of HIV/AIDS on the health sector: national survey of health personnel, ambulatory and hospitalised patients and health facilities outlines how the increase in those needing care will also require additional services being made available. These include antiretroviral therapy, food security, improved nutrition, voluntary counselling and testing and home-based care.

It is not only clinical staff that are affected, as loss of workers and capacity impacts upon all levels of health systems. For example, key staff in ministries of health are affected with a loss of capacity to address serious systematic problems, making their ability to tackle the disease more difficult.

Human capital and the HIV epidemic in Sub-Saharan Africa outlines how the HIV epidemic not only reduces the stock of those with higher level professional and managerial training and experiences, but also reduces ability to maintain the flow of those with needed skills and training. Training and educational institutions are themselves losing staff due to HIV and AIDS, reducing their capacity to meet growing demands.

Human resources for health and the global HIV/AIDS pandemic suggests that increased funding is needed immediately to address the growing crisis. The author also suggests that establishing an African Human Resources observatory would promote evidence-based policy, and help policy makers to share experiences.

ARVs

A critical issue in considering the impact of HIV and AIDS on human resources is the ability to deliver ARVs (anti-retrovirals) to those who most need them. It has been argues that human, rather than financial, resources represent the main constraint to implementing treatment plans in southern Africa . Yet none of these countries currently has a comprehensive human resource strategy.

In Scaling-up anti-retroviral treatment and human resources for health: what are the challenges in sub-Saharan Africa?, Kaspar Wyss outlines how human resources for health issues are an essential component to scaling up ARV delivery in low-income countries in Africa . These constraints include the availability of personnel with clinical, nursing, counselling, pharmaceutical and laboratory skills are critical to the pace of scaling up delivery. The author suggests that increasing training capacity, including investments in institutions, is necessary to scaling up services. However, massive scaling up of ARV delivery may also seriously deplete the provision of other priority services and threaten the strengthening of district based health services.

In Human resources for health and ART scale-up in sub-Saharan Africa the authors stress the need to rethink the adequacy of current ART delivery models. They point to context-specific delivery models that rely much less on medical doctors in situations where they are in short supply. They argue that, in order to deal with necessary scale-up requirements, new models should be centred around expert patients and their communities, rather than doctors.
In Mozambique the DREAM project is attempting to scale up interventions for HIV and AIDS through an integrated approach to prevention and treatment, drawing on a range of trained health workers and community members.

Tools

• Human resource management rapid assessment tool for HIV/AIDS environments: a guide for strengthening HRM systems This rapid assessment toolkit aims to help strengthen managerial skills and the ability of human resource managers to respond to HIV and AIDS.