"Will we achieve universal access to HIV/AIDS services with the health workforce we have?"
“If you really want to improve health care systems and to increase treatment, we have to have more qualified health care workers. Africa has 10 % of world's population, 25% of its health burden and 3% of its health care workers. We need more people in the health care workforce. Specifically, we need more people who can do good work at lower cost over a wider geographical range, than doctors can do alone in poor. In Zambia we worked with the government to add 1000 doctors in less 18 months. This didn't take very much new money. What it took was different organization and determined local leadership", said former US President William J. Clinton at the keynote speech at the opening session of the AIDS 2010 Conference in Vienna.
Given the 2010 deadline for universal access set by world leaders, AIDS 2010 coincided with a major push for expanded access to HIV prevention, treatment, care and support. With a global economic crisis threatening to undermine public investments, the conference helped keep HIV on the front burner, a chance to demonstrate the importance of continued HIV investments to broader health and development goals.
UNAIDS; PEPFAR and the Global Health Workforce Alliance (the Alliance) hosted a satellite session during the AIDS 2010 Conference - Health Workforce crisis – a bottleneck and priority to achieve HIV Universal Access - to continue the debate across different constituencies for advancing global thinking on HIV/AIDS and health workforce issues. On the question "Will we achieve Universal Access to HIV/AIDS services with the health workforce we have?” the answer that emerged from the lively discussions with the audience during the satellite session held on Wednesday 21 July was clearly no. Even though progress is being made, it is not sufficient to meet the 2015 MDG deadline.
Opening the satellite session, Dr. Sigrun Møgedal, Chair the Alliance and moderator of the session said “there is a call for not just a treatment workforce but also a prevention workforce". She set the scene by highlighting the critical problems related to the lack of health workers in many countries - limited training capacity, weak management systems, poor working conditions, lack of data, migration and the Global code of practice on international recruitment of health personnel. "We know that the global shortage is not just a matter of numbers, but it's compounded by uneven geographical distribution both within countries and across countries and regions" she said.
Dr Hirotsugu Aiga, Coordinator of the Alliance, gave an overview of how the Alliance works with all stakeholders on the response to the HRH crisis. He highlighted potential solutions recently announced such as the involvement of the Community Health Workers (CHW) and Task Shifting. Dr Thomas Kenyon from PEPFAR and co-chair of the Alliance technical working group (TWG) on HRH and HIV Universal Access, presented snapshot findings of the TWG from five countries (Côte d'Ivoire, Ethiopia, Mozambique, Thailand and Zambia) - all five countries have a strategic plan that address HR gaps and challenges and were employing methods to increase retention and improve workforce distribution. “Countries are engaging in task shifting as part of the strategy to decentralize universal access services to rural setting and primary care setting and to further integrating HIV services while also increasing access".
Government representatives of Malawi and South Africa spoke on their efforts to scale up HRH in the field of HIV. Dr Frank Chimbwandira, Director of HIV/AIDS at the Ministry of Health in Malawi said that a major focus of the country was to increase access to antiretroviral therapy, through drastically increasing the health workforce, thanks to increased donor funding. According to Dr Yogan Pillay, Deputy Director of Strategic Health Programmes, Department of Health, South Africa, the country has significantly scaled up its workforce through a number of new initiatives, approaches and projects such as integrating mid-level providers, partnerships with the private sector, improving management effectiveness. However, challenges remain - “policy makers make the changes and do not think about the impact on health workers, nor do we consult health workers. […] If we do not take care of health workers, they will not take care of patients, and we will not be able to scale up effectively".
What came out of the session in a clear and powerful way is that there are great hopes for improved access to health services for people living with HIV, however the situation is so complex that there cannot be one fit for all solution. Task shifting is being recognized but questioned at the same time, health system and management efficiency improvement are called upon, and priorities have to be set clearly, all these are urgently needed to be addressed in order to translate theory into action.
A report on the satellite will be available shortly.
The Alliance had a booth at the exhibition area of the conference to provide visitors with information about the Alliance as well as all major publications and products.