Anticipating significant scale-up of its current HIV/AIDS services, the Zambian Central Board of Health commissioned this study of the human resource implications. The study collected data at 16 government, NGO, and private for-profit sites across Zambia that currently provide VCT, P-MTCT, and ART services. It analyses the time taken to carry out the prescribed tasks involved in each of the services, describes the present workforce involved in providing these services and the extent to which services are currently following national service delivery standards, and projects the human resource requirements and costs associated with scaling up services to planned levels.
Human Resources
Although the Organisation for Economic Co-operation and Development (OECD) member countries generally favour long-term policies of national self-sufficiency to sustain their medical workforce, such policies usually co-exist with short-term or medium-term policies to attract foreign physicians. As this is likely to continue, there is a need to create a global framework that enforces physician migration policies that confer benefits on home and host countries. In the long-term, OECD member countries need to put in place appropriate education and training policies rather than rely on physician migration to address their future needs.
"The nations of the world are setting ambitious health and development goals, including the World Health Organization (WHO) target of providing AIDS treatment to 3 million people by 2005 and health-related UN Millennium Development Goals. Unless greater attention by donors and governments is given to developing human resources, these goals almost certainly will not be met. Many of the countries in sub-Saharan Africa, the region that will be the focus of this report, are experiencing severe shortages of skilled health care workers. There are multiple causes, the significance of which varies by country, but one of the most important factors is brain drain. Brain drain is defined in this report as the exodus of health care workers from developing nations to the wealthier countries of the North."
The quality of health care is hugely dependent on the skills of health professionals. Clinical skills centres are neutral and protected settings in which a variety of skills and techniques can be taught. In developing countries, resource constraints and pressure to direct skilled staff away from teaching to working in health service facilities can limit the opportunities for developing and implementing an effective training curriculum.
The UK is currently prominent as an active recruiter of health workers, most notably doctors and nurses. This is unlikely to change in the short term. The demographics in many developed countries such as the UK- a growing, ageing population and an ageing nursing workforce- make it likely that many of these countries will be actively encouraging inflow of health workers. Stopping migration is unlikely to be a viable option -which essentially leaves two other policy stances - non intervention, or some level of intervention to attempt to manage the migration process so that it is nearer “win –win”, or at least is not exclusively “win- lose”, with the countries that can least afford to lose being the biggest losers.
The provincial health department [Western Cape] has lost nearly 4 000 staff in the past six years - and there are no plans to replace them. But the department does not intend to let the numbers drop further. In his budget speech in the provincial legislature, Health MEC Pierre Uys said the department was losing staff at the rate of 1 000 a year.
Substitute health workers are cadres who take on some of the functions and roles normally reserved for internationally recognized health professionals such as doctors, pharmacists and nurses but who usually receive shorter pre-service training and possess lower qualifications. The findings raise interest in expanding the use of substitute cadres, as the demands of expanding access to services such as antiretroviral treatment requires substantial human resources capacity.
The biggest and most important component of any health system is its human resources (HR). The effective, equitable and appropriate production, training and deployment of health workers has been associated with periods of high health gain in southern Africa. Despite this, many health systems in southern Africa now face a variety of HR problems and personnel scarcities have become a critical limiting factor in health interventions. Health worker migration is further compounding inequities and stresses. Responding to economic and social triggers, personnel flow from rural to urban areas, from public to private sectors, from lower to higher income countries within southern Africa and from African countries to industrialized countries, exacerbating inequities and providing a reverse (poor to rich) subsidy. However a new policy momentum exists in relation to human resources for health.
Members of the African Union struck a deal with wealthy members of the World Health Organisation to be compensated for the loss of their health care workers to richer countries, the Nairobi Daily Nation reports. The negotiations were held during the 57th World Health Assembly in Geneva May 17-22. "The African Union pushed the agenda of compensation as one voice and we will jointly negotiate the terms like the European Union does," said Gideon Konchella, Kenya's assistant minister for health.
The provision of health services to rural and remote communities has been the source of much concern and debate in recent times. One aspect of this is the universal problem of insufficient medical practitioners in rural areas and the associated issues of recruitment and retention. Rural communities can play an important role in the recruitment and retention of health professionals, particularly in terms of aiding the integration of health professionals and their families into the community.