Mind the Deadly Gaps: Health Care Worker Shortages in Southern Africa Causing Fatal Delays in Bringing AIDS Care to Those in Urgent Need
Mexico City, 3 August 2008 — On the opening day of the XVII International Aids Conference, Médecins Sans Frontières (MSF) warned of the deadly impact that the lack of health care workers is having on AIDS treatment and care in southern Africa. In a satellite meeting called “Mind the Gaps” organised by MSF here today, experts described the scope and impact of the health care worker shortage as well as the critical need to increase government and donor commitment to taking immediate concrete steps to retain and support health care workers now.
“In Thyolo district, Malawi, one nurse keeps 400 patients alive by following up their essential treatment, but her basic salary amounts to just $3 a day,” says Dr. Moses Massaquoi, MSF medical coordinator in Malawi. “It is intolerable to then be told by governments and donor countries that it is unsustainable to raise her wages, even though she is responsible for $7,500 worth of drugs a month for her patients. Those willing to support funding for medicines must find ways to cover recurrent costs like salaries for health workers.”
An estimated 70 percent of people living with HIV/AIDS who need antiretroviral therapy (ART) are still not receiving it and the growing numbers of those who have been started on ART have only increased the burden on existing health care staff. They have little time to dedicate to proper treatment and follow up of their many patients, potentially resulting in low quality of care and treatment interruption as patients become discouraged by the long waiting times for consultations.
One successful strategy being piloted by MSF and others aims to better utilize existing health care worker staff, especially in rural areas. With proper training and support, nurses and lay counsellors can reach more patients, without compromising on quality and continuity of HIV/AIDS care. MSF data being presented at the XVII IAC in Mexico City shows that such targeted ‘task shifting’ has allowed much quicker roll out of ART in Malawi, Lesotho, South Africa and Rwanda without loss of quality of care. Task shifting, however, is no panacea to the health care worker shortage. It cannot replace concrete action to tackle the fundamental problems undermining the health workforce.
Low salaries, poor working conditions, and a lack of support and supervision are just a few of the reasons why it is growing increasingly untenable for many health care staff to stay and keep providing quality care. Initiatives by government policymakers and donors to slow the “brain drain” of health workers to richer countries in the long term cannot resolve the current crisis. Retaining health care workers working right now in hospitals and clinics as well as attracting additional staff must be the most urgent priorities.
“It is devastating to stand by and watch people growing sicker – and sometimes dying – as they wait weeks and even months before being treated simply because there are not enough health care workers,” says Dr. Mit Philips of MSF. “Overworked, underpaid and undervalued, health care workers in southern Africa are increasingly scarce just as the number of HIV patients is rising. Antiretrovirals may be present on more hospital and clinic shelves, but without the health staff to administer them, a deadly gap will only grow wider.”
The recent move by the Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM) to allow funding for more general health system strengthening is a step in the right direction. Countries should target this additional funding to retain and boost clinic health workers directly involved in patient care. Limits on salary and workforce spending by national and international financial institutions must also be lifted or recruitment of extra health staff and salary increases will continue to be restricted, even with additional international money.
The international medical organization Médecins sans Frontières (Doctors Without Borders/MSF) provides antiretroviral treatment to 140,000 patients (including 10,000 children) in 27 countries.