Friday, 1 November 2013

Overview of the impact of HIV/AIDS on the health workforce

BEING HUMAN MEANS A SIMPLE LIFE WITH GOOD FAITH AND ACTION

Overview of the impact of HIV/AIDS on the health workforce

This paper addresses one of the key global health challenges today, especially in the poorest
countries: the influence of the HIV/AIDS epidemic
on the health workforce. First, we provide an
overview of the impact of HIV/AIDS on health systems and how this influences demand and supply
of the health workforce, with a focus on developing countries. Second, we review the impact of
HIVAIDS on morbidity and mortality among staff, with specific emphasis on countries in Africa.
Next, we review the impact of HIV/AIDS on work
force motivation, performance and migration. Last,
we discuss policy options for future staff scenarios and potential obstacles, highlighting policies that
could improve retention, replacement and replenishment of health workers.
In fragile health systems, as is
the case in most resource-constrained countries, the human resource
crisis is the result of many macroeconomic and governance factors. The crisis is further compounded
by the impacts of the HIV/AIDS pandemic, which
lead to excessive workload and burnout, high
worker attrition rates with no replacement and limited entry into the workforce. The solutions to this
crisis must therefore include addressing the broader macroeconomic factors as well as the more
proximate factors that influence human resource-related functions of the health system.
The
World health report 2006
provides the first-ever global, regional and country profiles of workers
in the health sector and gives new evidence about health worker demographics, as well as
recommendations for the future human resource fo
r health development. Our background paper
highlights key data and discusses complex and often
controversial issues that
must be addressed in
support of the report’s goal.
Definition and importance of
the health workforce
According to WHO, human resources for health
(HRH) are the men and women who make health
care happen. They include nurses and midwives, pharmacists, physicians, dentists and other health
professionals. They also include auxiliary health care workers, community health workers,
practitioners of traditional medicine, technicians and other
paraprofessional personnel (1).They are
important because the existence and quality of services to promote health, prevent illness or to cure
and rehabilitate depend on the knowledge, skills and motivation of
human resources for health.
Countries must ensure that their health systems get the right number of service providers with the
right skills to the right place at the right time. They
must also ensure that the service providers operate
within an environment that enables them to adhere
to internationally accepted and nationally adapted
standards of care, thus assuring services of good quality.
There are a range of indicators to measure the human resources capacity in a country’s health services
system. The principal indicator is the proportion of health workers to the total population. Because
occupational classifications are country-specific
and the method for counting these workers has not
been standardized, it has been difficult to compare
HRH capacities across countries. For this reason,
traditionally key cadres such as doctors and nurses have been used
to estimate the HRH capacities.
With the advent of HIV/AIDS, other cadres crucial to
the delivery of care and treatment services, such
as counselors, have become very important. Home-based care has placed a large burden for care and
treatment, including psychosocial and nutritional supp
ort (both crucial to adherence and effectiveness
of care and treatment), on the family and on community health workers (CHWs). The ratios of family, CHWs, and traditional cadres of providers to the general population and to the population of clients
seeking facility-based services would give a better
indication of the HRH capacity of the country’s
health system. Accurate measurements of these populations are not always available (2).
The magnitude of the health workforce crisis
Health workers are crucially important as a res
ource for producing good health for the population.
They constitute 1 in 20 employed workers in the global economy and perform key social roles in all
– 2 –
societies. The inequities faced by developing
countries are reflected in Figures 1 and 2
below, which
highlight the disproportionate ratio of doctors and nurses in Europe and North America as compared
with Africa and Asia. There is a 250-fold variation among countries in ratio of doctors per 100 000
population and 400-fold variation in the ratio of nurses per 100 000 population (3).
Figure 1. 250-fold variation in supply of doctors among countries, ratio of doctors per 100 000
population
0 100 200 300 400 500 600
Liberia
Burkina Faso
Somalia
Lesotho
Sierra Leone
Angola
Madagascar
Mauritania
Guinea-Bissau
Congo
Nepal
Bangladesh
Cambodia
Maldives
Malays ia
Romania
Croatia
Aus tralia
Denmark
Aus tria
Sweden
Ic eland
Hungary
Norway
Belarus


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