A major obstacle to success in fighting HIV/AIDS is the lack of health care workers. In fact, in Africa, Asia, and other regions, people are facing their untimely demise since there are hardly enough health care professionals like physicians, nurses and other health workers. These staff members are needed to educate people about HIV prevention, administer HIV tests, prescribe and monitor treatment, and care for the sick.
The shortage of personnel also extends to the counselors and social workers who provide essential assistance to victims of sexual abuse and other violence, as well as those who provide care and support to orphans and other vulnerable children.
The critical shortages of health workers have been pointed out by the World Health Organization (WHO) in 57 nations. Africa has 36 countries listed there. Because of these shortages, WHO says that these countries are “very unlikely” to achieve global targets for controlling HIV/AIDS, tuberculosis, and malaria, or reducing maternal and child mortality.
The shortages are most severe in sub-Saharan Africa, where 3% of the world’s health workers struggle to combat 24% of the global disease burden. WHO estimates that sub-Saharan African faces a shortage of more than 800,000 doctors, nurses, and midwives and an overall shortage of 1.5 million health care workers. What’s more, health workers who do find employment are often distributed very unevenly within countries, as richer and more urban areas typically have many more health workers than poorer and harder to reach rural areas.
Poor Countries Struggle to Build Strong Health Systems
The health worker shortage is brought about predominantly by the challenges in the health systems in poor countries. They encounter difficulties in appointing acceptable numbers of personnel and paying them with reasonable salaries.
One factor underlying this problem is the decades of bad advice given to poor countries by international lenders like the International Monetary Fund and the World Bank. These lenders have required borrowers to contain government spending in order to achieve inflation levels far below what many economists believe is necessary. The result has been that government officials have lacked the flexibility to hire more health personnel or spend the money required to provide adequate salaries, benefits, and working conditions. Even countries that are not heavily indebted to the IMF and World Bank still need their stamp of approval in order to receive essential assistance.
Low salaries and poor job opportunities leads to a phenomenon known as “brain drain,” in which countries who have invested in training health care personnel then see them emigrate in large numbers to wealthier countries. In Ghana, for instance, 50% of medical school graduates emigrate within five years, and 75% within 10 years. Wealthy nations, facing their own shortage of trained personnel, sometimes actively recruit trained health care workers from Africa and other regions.
Many of the health workers who do remain in their home countries lack professional training opportunities, lack adequate supervision, and have unmanageable workloads. They must endure poor and sometimes unsafe working conditions. Basic supplies such as latex gloves and face masks-and equipment to provide standard diagnostic tests-are often unavailable. Without the tools to do their jobs properly, health workers can become demoralized and may emigrate or leave the health sector altogether.
Current global HIV/AIDS and health institutions and initiatives are not aligned well enough with national strategies. For instance, personnel sometimes leave the public health service in order to work for programs that are funded by wealthy countries, weakening public clinics and hospitals where these workers are desperately needed.
HIV/AIDS also has a massive direct effect on the health workforce. It is conservatively estimated that 16% of South Africa’s existing health worker force is HIV-positive, and that Malawi loses nearly 3% of its workforce to HIV/AIDS each year.
What Needs to be Done?
Countries need the flexibility to increase the number of working health care personnel and to improve their salaries. A global advocacy campaign is underway to persuade the wealthiest countries, which largely control the policies of international lenders, to require these agencies to give countries the flexibility they need. The campaign is also encouraging countries to set their own path in making budgetary decisions, independently of the advice of the international lenders. People in many African countries are also pressing their governments to keep a promise made in 2005 to increase spending on health to 15% of the national budget.
The labor policies of wealthy countries must also be changed. These countries must stop actively recruiting health professionals from developing countries, except as part of an agreement with those countries. Wealthy countries should also take steps, such as expanding admission to nursing schools, which will help them become more self-sufficient in meeting their own health worker needs.
Another strategy is to make more effective use of community health workers. These non-professionals are rooted in their communities and are less likely to emigrate in search of better wages and working conditions. They have deep knowledge of their communities, where they are familiar and trusted neighbors.
Sometimes, donor countries and their development agencies have used these community workers as volunteers. But, a better solution is to provide these workers with at least a stipend, if not a living wage, as well as training and supervision by health professionals. For instance, in Haiti and other locations, Partners in Health has successfully used community workers to provide a broad range of services, including drug distribution, disease observation and reporting, clinical referrals, and social support for people with chronic illness, while paying them a stipend.
Finally, the shortage of health care personnel is so severe and health care infrastructure so weak that poor countries need well-targeted aid from international agencies and wealthy countries. Countries that have not already done so also need to develop national human resource plans as a part of comprehensive country health plans involving a wide range of stakeholders. Wealthy countries should then provide the resources needed to finance plans that meet high standards of quality and increase equitable access to health care.
The cost of doubling Africa’s health workforce was estimated at $2 billion in 2006 and is expected to rise to about $7.7 billion annually by 2010. This would be money well-spent, because it would help ensure the billions of dollars being provided to fight AIDS, tuberculosis, and malaria can be fully and effectively used. It would also help Africa provide better reproductive and sexual health services.