Scaling up access to antiretroviral treatment in southern Africa: who will do the job?

doi:10.1016/S0140-6736(04)16597-5

The Lancet

Volume 364, Issue 9428, 3–9 July 2004, Pages 103-107

https://doi.org/10.1016/S0140-6736(04)16597-5 Get rights and content

Summary

Malawi, Mozambique, Swaziland, and South Africa have some of the highest HIV/AIDS burdens in the world. All four countries have ambitious plans for scaling-up antiretroviral treatment for the millions of HIV-positive people in the region. In January 2004, we visited these countries with the intention of directly observing the effect of AIDS, especially on health systems, to talk with policy makers and field workers about their concerns and perspectives regarding the epidemic, and to investigate the main issues related to scaling up antiretroviral treatment. We found that financial resources are not regarded as the main immediate constraint anymore, but that the lack of human resources for health is deplored as the single most serious obstacle for implementing the national treatment plans. Yet, none of the countries has developed an urgently required comprehensive human resource strategy. This may also need increased donor attention and resources.

Section snippets

Background

Travelling through Malawi, Mozambique, Swaziland, and South Africa, AIDS is an obvious and visible concern in all four countries. Mass prevention campaigns have left their mark, from roadside billboards, to condom promotion posters, to mural paintings in the inner cities (figure 2). These campaigns, however, are difficult to evaluate and reduction of infection rates remains a major challenge.¹

The rates of adult HIV-infection in the four countries are among the highest in the world, ranging from

Financing the response to HIV/AIDS

In recent years, the global response to AIDS has entered a new phase. The Global Fund to Fight AIDS, Tuberculosis, and Malaria started to operate in January, 2002, and had by April, 2004, disbursed almost US$150 million for HIV/AIDS.¹⁰ The World Bank is committing large amounts of funds through its Multicountry HIV/AIDS Programme for Africa (MAP) and private foundations, such as the Bill and Melinda Gates Foundation, and the Clinton Foundation are contributing to increased funding for HIV/AIDS.

The human resource reality

About 30 minutes drive south of Blantyre, we arrive at the rural district hospital of Thyolo. We are welcomed by Roger Teck, head of a Médecins Sans Frontiéres (MSF) mission running an HIV/AIDS project in the district. On our visit, the hospital is overcrowded with patients lying in beds and on the floor (figure 3).

MSF reckons that in Thyolo district around 50 000 people are HIV positive and that about 8000 people are in need of antiretroviral treatment; however, fewer than 400 are receiving

Tackling the human resource crisis

In Thyolo, where only 40% of posts in the public health sector are filled, MSF has recruited extra staff, thus adding another 20% to the health workforce. Nevertheless, this number is not sufficient to cope with the normal workload, let alone with the extra HIV/AIDS-related burden. MSF acknowledges that “we can only do this because we are a pilot project, for scaling up antiretroviral treatment, solutions for the human resource crisis must be found at the national level”. The recruitment logic

Present measures are falling short

Will what is being done and what is being proposed to tackle the human resource crisis be sufficient to turn the tide? Our observations in the health facilities and our interviews with people from all levels of the health systems in the four countries make us doubt this. We did not come across a truly comprehensive national human resource strategy, even though the lack of health workers is acknowledged everywhere as the most seriously lacking resource for realising the national AIDS plans.

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ReportageScaling up access to antiretroviral treatment in southern Africa: who will do the job?

Summary

Section snippets

Background

Financing the response to HIV/AIDS

The human resource reality

Tackling the human resource crisis

Present measures are falling short

Lancet

Lancet

Lancet

Soc Sci Med

Lancet

“Letting them die”: why HIV/AIDS prevention programmes fail

AIDS epidemic update: December 2003

Country data

National HIV and Syphilis Antenatal Seroprevalence Survey in South Africa: 2002

Treatment of AIDS: the 2 year plan to scale up antiretroviral therapy in Malawi

República de Moçambique. Ministério de Saúde

PEN ITS/HIV/SIDA –sector saude 2004–2008 (preliminary version)

The health sector response to HIV/AIDS plan in Swaziland; 2003–2005

Operational Plan for comprehensive HIV and AIDS care, management and treatment for South Africa

Reportage
Scaling up access to antiretroviral treatment in southern Africa: who will do the job?