in
developing countries
Linda Tawfik
Management Sciences
for Health
Cambridge,
Massachusetts
Stephen N. Kinoti
Quality Assurance
Project (QAP)
University Research
Co., LLC
Bethesda, Maryland
March 2006
Background paper
prepared for
The world health report
2006 - working together for health
©
World Health Organization 2006
The
designations employed and the presentation of the material in
this
background paper do not imply the expression of any opinion whatsoever on
the
part of the World Health Organization concerning the legal status of any
country, territory, city or area or of its authorities, or concerning the
delimitation
of its frontiers or boundaries. Dotted lines on maps
represent
approximate border lines for which there may not ye
t be
full agreement.
The
mention of specific companies or of certain manufacturers’ products does not
imply that they are endorsed or recommended by
the
World Health
Organization
in preference to others of a similar nature that are not mentioned. Errors and
omissions excepted, the names of proprietary products
are
distinguished by initial capital letters.
All
reasonable precautions have been taken by the World Health Organization to
verify the information contained in this background paper.
However,
the published material is being distributed without warranty of any kind,
either expressed or implied. The responsibility for the
interpretation
and use of the material lies with the reader. In no event shall the World
Health Organization be liable for dam
ages
arising from its use.
This
background paper was commissioned by WHO as background for the World Health
Report 2006. The authors alone are responsible
for
the
views
expressed, which do not necessarily represent the decis
ions
or the stated policy of the World Health Organization.
Overview
of the impact of HIV/AIDS on the health workforce
.....................................................................
...............
1
Definition
and importance of the health
workforce..............................................................................
........................
1
The
magnitude of the health workforce crisis
...................................................................................
..........................
1
Why
the concern?
...............................................................................................................
.................................
3
Loss
rates by cadre ............................................................................................................
..................................
4
Why
are health workers absent?
.................................................................................................
........................
4
Unfilled
posts in the health sector
............................................................................................
............................
4
The
gender
dimension...........................................................................................................
...............................
5
Health
system effects of HIV/AIDS
..............................................................................................
........................
5
HIV/AIDS-related
morbidity and mortality among health workers
..................................................................
............
8
HIV/AIDS-related
morbidity
.....................................................................................................
.............................
8
HIV/AIDS-related
mortality
.....................................................................................................
..............................
8
Policy
implications of morbidity and mortality
.................................................................................
.....................
9
Impact
of HIV/AIDS on workforce motivation, performance and migration
..........................................................
....
10
Motivation
and
performance.....................................................................................................
..........................
10
Migration
......................................................................................................................
.......................................
11
Attrition
of health workers in Africa
..........................................................................................
..........................
11
Policy
options for the future
..................................................................................................
.....................................
12
Policy
goal
....................................................................................................................
......................................
13
Current
policy gaps and obstacles.................................
.............................................................
.......................
13
Recommendations
for future policy ..............................................................................................
.....................
19
Conclusion
.....................................................................................................................
............................................
21
Annex
1. Summary of lessons learnt
.............................................................................................
...........................
22
Background
to the consultancy ..................................................................................................
........................
22
Methodology
....................................................................................................................
...................................
22
Initial
findings...............................................................................................................
.......................................
22
Recommendations
................................................................................................................
.............................
23
List
of figures
Figure
1. 250-fold variation in supply of doctors among countries, ratio of doctors
per 100 000 population ........... 2
Figure
2. 400-fold variation in supply of nurses among countries, ratio of nurses per
100 000 population ............. 2
Figure
3. Projection of health workers with AIDS, Botswana
.....................................................................
...............
3
Figure
4. Reported TB patients in Swaziland, 1991–2004
.........................................................................
...............
6
Figure
5. Caseload in Kenyan facilities, 1996, 1999 and 2002
...................................................................
..............
6
Figure
6. Expansion of ART services
............................................................................................
.............................
7
Figure
7. Health worker attrition due to death, Mozambique Ministry of
Health..................................................
......
9
Figure
8. International migration of nurses to the United Kingdom from selected
African countries, 1998–2003.. 11
Figure
9. Attrition of health workforce staff, Kenya,
1996–2001................................................................
..............
12
Figure
10. Causes of attrition among health workers in six selected districts, Malawi,
1996–2002 (n=527) ......... 12
Figure
11. Improvements in staff satisfaction, Uganda, 2004
....................................................................
.............
18
Figure
12. Improvements in staff performance, Uganda, 2004
.....................................................................
..........
18
This paper addresses
one of the key global health challenges today, especially in the poorest
countries: the
influence of the HIV/AIDS epidemic
on the health
workforce. First, we provide an
overview of the impact
of HIV/AIDS on health systems and how this influences demand and supply
of the health
workforce, with a focus on developing countries. Second, we review the impact
of
HIVAIDS on morbidity
and mortality among staff, with specific emphasis on countries in Africa.
Next, we review the
impact of HIV/AIDS on work
force motivation,
performance and migration. Last,
we discuss policy
options for future staff scenarios and potential obstacles, highlighting
policies that
could improve
retention, replacement and replenishment of health workers.
In fragile health
systems, as is
the case in most
resource-constrained countries, the human resource
crisis is the result
of many macroeconomic and governance factors. The crisis is further compounded
by the impacts of the
HIV/AIDS pandemic, which
lead to excessive
workload and burnout, high
worker attrition rates
with no replacement and limited entry into the workforce. The solutions to this
crisis must therefore
include addressing the broader macroeconomic factors as well as the more
proximate factors that
influence human resource-related functions of the health system.
The
World health report
2006
provides the
first-ever global, regional and country profiles of workers
in the health sector
and gives new evidence about health worker demographics, as well as
recommendations for
the future human resource fo
r health development.
Our background paper
highlights key data
and discusses complex and often
controversial issues
that
must be addressed in
support of the
report’s goal.
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