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
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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