Scaling Up Treatment for the Global AIDS Pandemic Challenges and Opportunities (2005) / Chapter Skim
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Appendix E: Human Resource Requirements for Scaling Up Antiretroviral Therapy in Low-Resource Countries
Appendix E: Human Resource Requirements for Scaling Up Antiretroviral Therapy in Low-Resource Countries
Pages 292-308
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From page 292... ...
. Difficulties in developing and retaining a sufficient number of skilled health workers is by no means a new problem, but the sheer scale of the HIV/AIDS epidemic, and its impact on human resources through an array of both supply and demand-side factors, has made the problem much worse.
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From page 293... ...
In short, it is possible that in many settings the human resource constraint will be a greater obstacle to program expansion than the financial constraint. The purpose of this chapter is to provide illustrative estimates of the human resource requirements for achieving the PEPFAR goal of treating 2 million patients with ARVs.2 There is a rapidly growing literature on the impact of HIV/AIDS on human resources for health, touching on both the complex nature of the problem as well as possible solutions (Aitken and Kemp, 2003; USAID, 2003)
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From page 294... ...
APPROACH Estimation Approach The basic calculation undertaken in this paper is to estimate human resource requirements by multiplying the number of patients receiving care by the per-patient time requirements for service delivery, and then dividing by the amount of time that each health worker can spend seeing patients in a year. This is shown in Box E-1.
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From page 295... ...
To estimate this parameter, the contractual level of effort must be modified to take into consideration holidays, vacation, sick leave, and training activities (all of which will cause absences from the workplace) , as well as waiting time, administrative duties, cleaning and maintenance tasks, and other activities that curtail time available to spend with patients even while at work.
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From page 296... ...
. In this paper it is conservatively assumed that there will be no change through 2008 from current data on the number of health workers available.5 Supporting Services: VCT and OI Treatment The expansion of ART requires a capacity to provide supporting services as well, and these will require human resources of their own.
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From page 297... ...
VCT also offers important benefits as a prevention tool, and so human resource requirements for VCT should be seen as contributing to the achievement of PEPFAR's prevention goal of averting 7 million new infections as well. What level of VCT service provision should human resource estimates be based upon?
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From page 298... ...
Each individual patient in reality will require a different amount of time with health workers depending on a variety of factors. Time requirements for ARV delivery, for example, will be higher for patients who are being initiated on treatment, or for those who are suffering from complications.8 Models of care may also vary 8The extent to which second-line treatment regimens are needed will have important implications for human resource requirements -- but this is an important unknown for large-scale programs in low-resource countries.
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From page 299... ...
A wide range of service delivery options is available and existing models of care may be unrealistic for scaling up to a national level. Note that VCT services are assumed to be performed by a nurse and a VCT counselor but not by a lab technician; in some cases only one person may do everything.10 For ARV delivery, lab technician time will depend on the number and type of tests to be performed, the technology applied, and even the model of equipment being used.
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From page 300... ...
The fraction of each country's existing doctor workforce required to reach PEPFAR coverage goals under Scenario 1 is shown in Figure E-1. For all countries, approximately 80 percent of the doctor requirements are for ARVs, with the remainder for OI treatment.
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From page 301... ...
. Scenario 2: Adding Community Workers In recognition of the obstacle to scaling-up posed by inadequate human resources, the PEPFAR plan proposes that alternative service delivery models could ease the burden by shifting certain duties to community workers.
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From page 302... ...
Doctor requirements are reduced by roughly 50 percent compared to Scenario 1. Nurse requirements decline by a narrower margin, since the "savings" generated by allocating some of their responsibilities to community workers are partially offset because they simultaneously adopt part of the doctor's role.
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From page 303... ...
, however, the human resource requirements will impose a large burden. The requirement of 206 doctors by 2008, as indicated in Table E-2, represents close to one-third of the existing doctor workforce in the country.
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From page 304... ...
High rates of workforce attrition will make program expansion even more challenging. Second, standards of service delivery in existing programs were found to be low, suggesting that quality of care considerations will become increasingly important as population coverage expands.
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From page 305... ...
These are placing similar demands on human capacity in the health sector but were not included in the estimates presented earlier. Since virtually all of the 20 million HIV-positive individuals in the 14 countries will become clinically eligible for treatment within the next 10 years, it may be asked hypothetically what the human resource requirements would be if every one of them were actually to receive ARVs at that time.11 The resulting doctor requirements, assuming the same model of care as in Scenario 1 above, are shown in Figure E-3.
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From page 306... ...
First, the scale of the problem is such that human resource requirements for HIV/ AIDS should not be viewed in isolation from other health sector human resource needs.12 More health personnel for ARVs will mean less for other priority services. Second, while the delegation of responsibilities to community lay workers is a sensible approach to the human resource constraint, these models should also be scrutinized from a quality of care perspective.
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From page 307... ...
No single solution will offer a magic bullet to the human resource challenge; countries will need to adopt multipronged strategies to fit local circumstances. But taken together they can help contribute to a more successful program expansion.
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From page 308... ...
. Office of the United States Global AIDS Coordinator.
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