HELP WANTED: Health worker shortage limits access to HIV/AIDS treatment in southern Africa

Severe shortages of health staff are compromising the quality and availability of HIV/AIDS care across southern Africa. There is wide acknowledgement of the human resource crisis, but little action on the ground. MSF is urging governments to develop and implement emergency plans to retain and recruit health care workers that include measures to raise pay and improve working conditions.

he dire lack of health care workers in southern Africa is threatening efforts to expand access to HIV/AIDS treatment, warned the international medical humanitarian organisation Médecins Sans Frontières (MSF) in a new report issued today.

The report covers four southern African countries - Lesotho, Malawi, Mozambique and South Africa - where more than one million people still need life-saving antiretroviral treatment but do not have access to it. Lack of action will result in unnecessary illness and death.

"In Thyolo district we are treating 7,000 people with HIV/AIDS. We need to increase this number to 10,000 by the end of the year, but our programme is hitting a wall because there are simply not enough nurses, doctors and medical assistants," said Veronica Chikafa, a nurse/matron working with MSF in Malawi.

Severe shortages of health staff are compromising the quality and availability of HIV/AIDS care across southern Africa. In Thyolo district in Malawi, a medical assistant can see up to 200 patients per day, far too many to ensure quality care. In Mavalane district in Mozambique, patients are forced to wait for up to two months to start treatment because of the lack of doctors and nurses, and many have died during the wait.

In Lesotho there are only 89 doctors in the whole country.

"Providing HIV care in rural clinics depends on nurses, but they are overwhelmed by the number of patients," said Dr Pheello Lethola, Field Doctor for MSF in Lesotho. "Consultation times are too short, and sick patients suffer needlessly. When nurses suffer, patients suffer."

There is wide acknowledgement of the human resource crisis, but little action on the ground. MSF is urging governments to develop and implement emergency plans to retain and recruit health care workers that include measures to raise pay and improve working conditions.

In most countries this will only happen if donors change their policies and start providing financial support for recurrent costs such as salaries. Ministries of finance and the International Monetary Fund (IMF) will need to find solutions to overcome "caps" on the number of health workers and level of salaries. Otherwise, governments will not be able to respond adequately to the unmet need for treatment.

Even in South Africa, which has more health care workers who are better paid compared to other southern African countries, unequal distribution and inadequate numbers of staff are causing delays to expanding treatment.

"Clinics are absolutely saturated, waiting lists are growing, and it feels like we are losing the battle, "said Dr Eric Goemaere, head of MSF's programme in Khayelitsha, Western Cape. "For people making policies in offices far away from patients, our message is that you will be held responsible if you are not reactive or flexible enough to find solutions to the staff shortages."

To expand access to HIV care in rural settings MSF teams have relied on "task-shifting" from doctors to nurses and nurses to community workers. But these are limited measures that do not remove the need for additional skilled staff.

"It is incomprehensible that donors provide funds for life-long aids treatment and the building of new clinics, but refuse support for health care worker salaries on the grounds that this is 'unsustainable,'" said Sharonann Lynch, Treatment Literacy Coordinator for MSF in Lesotho. "People living with HIV/AIDS do not only need drugs and clinics; they need trained, motivated health care workers to diagnose, monitor, and treat them."

In the four countries profiled in this report, MSF is presently providing antiretroviral treatment (ART) for nearly 30,000 people. Worldwide, MSF provides ART to over 80,000 patients in more than 30 countries.