Small antiretroviral drug programmes are beginning to take shape in some of the worst affected countries in Africa. But as the drugs flow in, the medical personnel needed to administer them are being lured away by the rich countries that talk loudly about finding a solution to Africa's AIDS crisis and whose companies provided the drugs. WHO estimates that only 750000 health workers are available to care for 682-million people in sub-Saharan Africa, which has more than 25-million people infected with HIV, or 60% of the global total.
Human Resources
Unless sub-Saharan African countries initiate workplace anti-AIDS programmes, the pandemic will decimate the region's human resource capacity, experts warned in the Ghanaian capital, Accra, in November. "African companies already find it difficult to compete in global markets," Ghana's presidential advisor on HIV/AIDS, Professor Fred Sai, told the fourth interactive meeting of the UN Commission on HIV/AIDS and Governance in Africa (CHGA).
This study explores the constraints related to human resources in the health (HRH) sector to achieving the Millennium Development Goals (MDGs) in low-income countries. The author finds that, at an individual level, the decision to enter, remain and serve in the health sector workforce is influenced by a series of social, economic, cultural and gender-related determinants.
A new study to be published in the Lancet has, for the first time, quantified the dangerous scarcity of healthcare workers in countries with climbing rates of HIV, tuberculosis and malaria. The report, 'Human Resources for Health: Overcoming the Crisis', says health workers from developing countries are lured by better salaries and safer working conditions in urban areas or richer countries, creating the so-called "brain-drain".
This article from the journal Human Resources for Health considers some of the effects of health sector reform on human resources for health (HRH) in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector. The introduction of market mechanisms often involves the formation of an internal market within the health sector and market testing of different functions with the private sector. This has immediate implications for the employment of health workers in the public sector, because the public sector may reduce its workforce if services are purchased from other sectors or may introduce more short-term and temporary employment contracts.
Human resources are the crucial core of a health system, but they have been a neglected component of health-system development. The demands on health systems have escalated in low income countries, in the form of the Millennium Development Goals and new targets for more access to HIV/AIDS treatment. Human resources are in very short supply in health systems in low and middle income countries compared with high income countries or with the skill requirements of a minimum package of health interventions. Equally serious concerns exist about the quality and productivity of the health workforce in low income countries.
As South Africa rolls out its national treatment programme, the country continues to lose skilled healthcare professionals to wealthier nations abroad, leaving severe shortages in an already over-stretched public health system. On a Tuesday morning earlier this month at Johannesburg General Hospital's medical wards, an exhausted-looking Dr Candace Latilla was about to go off duty. But, as the only doctor on call that night, she would be back in a couple of hours. Latilla has been working at the hospital as an intern doctor for the past nine months. With a staff component of 470 doctors and 1,300 nurses, Johannesburg General handles more than 1.5 million patient visits a year.
Much has been written about the impact of the HIV and AIDS pandemic on the healthcare delivery systems and resources in central and southern Africa. The unremitting pressure on hospitals and other healthcare facilities, and the disproportionate use of healthcare resources by the ever increasing numbers of patients, are threatening to undermine the capacity of countries such as South Africa to provide a comprehensive health safety net for the rest of the population, says an article in the British Medical Journal.
Migrant health workers are faced with a set of options that are a combination of economic, social and psychological factors and family choices. They trade decisions related to their career opportunities - and to financial security for their families - against the psychological and social costs of leaving their country, family and friends. The comments of health workers themselves reflect the "push and pull" nature of the choices underpinning these "journeys of hope". Demotivating working conditions, coupled with low salaries, are set against the likelihood of prosperity for themselves and their families (by remittances), work in well-equipped hospitals, and the opportunity for professional development. An article in the WHO Bulletin points out that young, well-educated individuals are most likely to migrate, especially in pursuit of higher education.
Imbalance in the health workforce is a major concern in both developed and developing countries. It is a complex issue that encompasses a wide range of possible situations. This paper aims to contribute not only to a better understanding of the issues related to imbalance through a critical review of its definition and nature, but also to the development of an analytical framework. The framework emphasizes the number and types of factors affecting health workforce imbalances, and facilitates the development of policy tools and their assessment.