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Published on January 10, 2008

Author: Sigismondo

Source: authorstream.com

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Antiretroviral Treatment (ART) & Human resources:  Antiretroviral Treatment (ART) & Human resources Wim Van Damme Department of Public Health ITM, 17 October 2006 Programme today:  Programme today Scale-up ART in developing countries Human resources as bottleneck AIDS = most prominent disease on political scene:  AIDS = most prominent disease on political scene AIDS = most prominent disease on political scene:  AIDS = most prominent disease on political scene Why? Deaths in South-Africa (a model for of future AIDS and non-AIDS Deaths):  Deaths in South-Africa (a model for of future AIDS and non-AIDS Deaths) Deaths at ages 15-34 South Africa: 1980-2025 (Estimated and projected ):  Deaths at ages 15-34 South Africa: 1980-2025 (Estimated and projected ) 0 400 800 1,200 1,600 2,000 Deaths (thousands) Without AIDS With AIDS Slide15:  Disease Slide16:  Dead Changes in life expectancy in selected African countries with high and low HIV prevalence: 1950-2005:  Changes in life expectancy in selected African countries with high and low HIV prevalence: 1950-2005 with high HIV prevalence: Zimbabwe South Africa Botswana with low HIV prevalence: Madagascar Mali 30 35 40 45 50 55 60 65 Life expectancy (years) 1950– 1955 1955- 1960 1960- 1965 1965- 1970 1970- 1975 1975- 1980 1980- 1985 1985- 1990 1990- 1995 1995- 2000 2000- 2005 Slide20:  AIDS orphans in South Africa Slide21:  Orphans AIDS = political issue…:  AIDS = political issue… Because AIDS in Southern-Africa = dramatic Demographic impact Economic impact Social impact Reduction in life expectancy  “social involution” “AIDS = Unprecedented health crisis” (!! ??) “AIDS = development crisis” “AIDS = potential security threat”(??) AIDS get a lot of attention worldwide. What are the consequences?:  AIDS get a lot of attention worldwide. What are the consequences? International reactions:  International reactions International political reactions to raise awareness & financial commitments International policy reactions aiming at operational results: prevention, treatment & care, impact mitigation Political reactions … leading to increased donor funding & international Aids policies.:  Political reactions … leading to increased donor funding & international Aids policies. Donor funding World Bank: MAP Creation Global Fund Private foundations: Gates & Clinton Bush Plan (=PEPFAR) International Aids policies UNAIDS WHO: ‘3-by-5’ Estimated people on ART (Dec 05):  Estimated people on ART (Dec 05) Human Resources for Health (HRH) in times of AIDS:  Human Resources for Health (HRH) in times of AIDS AIDS: which consequences for health staff? Who will do the job?:  Who will do the job? 3 steps in HRH:  3 steps in HRH HRH shortages & imbalances Impact of AIDS on HRH HRH needs for ART HRH shortages:  Source: WHO, 2004 (last update 26 Oct 2004) HRH shortages Impact of AIDS on HRH:  Impact of AIDS on HRH Increased disease burden (OIs, incl. TB, Malaria?)  Increased demand for care More consultations More hospitalisations Longer hospital stays “crowding-out effects” AIDS :  AIDS  Increased health worker attrition & absenteeism Health workers our dying from AIDS Increased absenteeism due to own illness illness of family members funerals Consequences for the remaining carers Increased workload Compelled to work longer hours, see more patients, assume more tasks “Burn-out” Workplace security (perceived?) risk of HIV infection Acceleration of HRH flows ??:  Acceleration of HRH flows ?? HRH crisis in sub-Saharan Africa:  HRH crisis in sub-Saharan Africa Absolute shortages & mal-distribution Worsened by AIDS  workload ↑↑↑  (?) Accelerated flows & Brain drain ART = labour intensive:  ART = labour intensive South-Africa: team of 11 staff for 500 patients on ART: 1 doctor, 2 nurses, 5 counsellors, … WHO review: 5 to 7 staff for 1000 patients Usually doctor-based models Health workers & PLWHAs (2004 data: UNAIDS & WHO):  Health workers & PLWHAs (2004 data: UNAIDS & WHO) “Emergency HRH plans” TTR = treat – train - retain:  “Emergency HRH plans” TTR = treat – train - retain Treat health workers Investment in HRH / health systems Need for more HRH through Training? Retention? Importation? Innovative solutions for ART delivery:  Innovative solutions for ART delivery “Task shifting”… … from MDs to clinical officers to nurses to … ‘lay providers’? Or community health workers? Simplification of treatment protocols? Group treatment?? – peer treatment?? (expert patients?) Implications: legal – financial – mentality - … “Need for a paradigm shift”?? In conclusion:  In conclusion AIDS in high-prevalence countries = dramatic for society dramatic for health system To tackle AIDS needs important investment ($/€) – but: feasible Money = becoming available (Global Fund – PEPFAR) But: capacity constraints: Who will do the job?  investment needed in health system, including human resources + adaptation of treatment models

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