Human Resources

Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers' perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support.

This paper describes the current situation of the health workforce in the public sector in Swaziland. Swaziland, like most other countries in southern Africa, is facing a human resources crisis that is exacerbated by the impact of HIV and AIDS. The paper identifies the major factors that contribute to losses in the health workforce as emigration and attrition due to AIDS. It describes the initiatives that the government has undertaken to tackle the crisis. These include retention strategies such as increased salaries to retain staff, and scaling up anti retroviral therapy (ART) for health-care workers to reduce attrition.

Absence of current reliable human resources data for health workers at the country level limits the ability to monitor and improve HRH leadership, management, policy and planning. Responding to this health workforce crisis, about 90 participants from fifteen African countries and international organizations have joined forces for the African Health Workforce Observatory. The East, Central and Southern African Health Community (ECSA), the World Health Organisation, World Bank and USAID/Capacity Project have partnered to accelerate the establishment of Africa Health Workforce Observatory. This three-day meeting focussed on developing mechanisms to create up-to-date reliable information that enables evidence-based decision making for human resources for health.

Southern Africa’s public health services are in a state of emergency. Bad pay and working conditions, plus the impact of HIV/Aids, are bleeding the system of its most valuable resource: people. With the cost of training a general practice doctor estimated to be $60 000, and that of training a medical auxiliary at $12 000, the African Union estimates that low income countries subsidise high income countries to the tune of $500-million a year through the loss of their health workers. The article touches on the experience in several eastern and southern African countries.