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There is a pressing need to scale up antiretroviral treatment (ART) for HIV. However, weak health systems remain a major obstacle, especially in those countries of sub-Saharan Africa hit hardest by HIV and AIDS. These countries face a shortage of health staff and a growing case-load of people requiring lifelong treatment.
Researchers from the Institute of Tropical Health, in Belgium, consider the kind of model needed for effective scale up of ART programmes given workforce constraints. Current ART models are labour-intensive, requiring many qualified staff. Countries such as Mozambique, Malawi, Zambia, Rwanda and Tanzania lack sufficient skilled human resources for health (HRH) to scale up ART according to such doctor-based delivery models.
The researchers find that ART delivery involves several types of function requiring different approaches. Good organisation of logistics, supplies and distribution calls for a standardised, centrally controlled or bureaucratic approach. However, a more society-based approach is needed when providing community support to patients. The management of patients who do not fit standardised procedures requires a more professional approach. Finally, care of the individual patient requires a combination of the social and professional approaches. The researchers also outline five possible scenarios with respect to ART delivery.
The researchers conclude that given the HRH crisis, ART delivery models requiring much less doctor time need to be developed. Overall, there is a need to shift tasks from medical doctors to nurses and from nurses to community health workers. In particular, the patients themselves need to play an important role in the delivery of ART. The outcomes of the various scenarios are predicted.
Most countries are likely to choose elements from all of these scenarios, depending on their local context and what reforms are taking place.
Source(s):
‘Scaling-up Antiretroviral Treatment in Southern African Countries with
Human Resource Shortage: How will Health Systems Adapt?’ Social Science &
Medicine, 66:10, pages 2108-2121, by Wim van Damme et al, 2008
id21 Research Highlight: 22 May 2008
Further Information:
Wim van Damme
Institute of Tropical Medicine
Nationalestraat 155 - B-2000
Antwerp
Belgium
Contact the contributor: wvdamme@itg.be
Institute of Tropical Medicine, Antwerp, Belgium
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outcomes in Malawi'
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'Passing the test: allocating antiretroviral therapy in Malawi'