Bureaucracy continues to impede HIV/AID treatment across Asia.

Not enough to go around: Arming health workers to fight maternal mortality Photo: Phuong TranWith the current number of health workers worldwide, most developing countries will not be able to achieve Millennium Development Goal 6, which includes universal access to HIV/AIDS treatment by 2015, according to a 2011 World Health Organization (WHO) report which reviewed progress in five countries.

By the end of 2009 only 36 percent of 14.5 million HIV-positive people in low- and middle-income countries in need of antiretroviral treatment (ART) received it, in large part because of the lack of healthcare workers, according to the UN.

New HIV treatment guidelines issued in late 2009 boosted the number deemed in need of treatment.

WHO estimated in 2006 a shortage of 4.3 million health workers globally - 1.5 million in sub-Saharan Africa alone. The need would only grow as the population grows and HIV infections increase, said the 2011 WHO report.

In analyses of HIV programming over the past decade in Côte d’Ivoire, Ethiopia, Mozambique, Thailand and Zambia, only Thailand - where the health worker shortage is less severe than in the other countries - had achieved near universal access to HIV medication (78 percent).

HIV prevalence in the five countries varied from 15.2 percent in Zambia to 1.4 percent in Thailand.

Community health workers

“We have to start somewhere,” said community health worker Maxensia Nakibuuka from Uganda, who is HIV-positive and founder of an NGO that has provided HIV care at no cost, out of her home, since 2005, reaching some 12,000 people in the past five years by her count.

Speaking at the report’s launch on 31 January in Bangkok, she said: “There is no national policy [in Uganda] that recognizes us [community health workers] for planning or budget support.”

She said 18 community health workers in her area, including herself, were running for parliament in an effort to influence national policy on HIV and improve care.

To manage health worker shortages, countries are increasingly turning to volunteer community health workers - including formally “task-shifting”, or reassigning them HIV care responsibilities typically handled by doctors.

“There is no sure quick fix [to the lack of health workers], just steps that need sustained long-term investment,” said Mark Stirling, UNAIDS country director for China and former UNAIDS regional director for eastern and southern Africa.

Recommendations

In addition to bolstering community health workers to take on HIV care and prevention, the report recommended:

- Not neglecting HIV prevention programmes at the expense of investing in human resources to increase HIV interventions, citing Thailand’s ability to reduce HIV infections through aggressive condom outreach with sex workers and brothel owners.

- Keeping health workers in remote areas. Before insecurity led to the flight of thousands from Côte d’Ivoire and halted basic services, including medical care, the country was piloting a project in the north that gave health workers quarterly bonuses based on HIV/AIDS performance.

- Figuring out how many health workers are needed to achieve universal access by developing human resource plans that factor in HIV-related goals and cost estimates. Only Côte d’Ivoire and Ethiopia of the five case studies have done this, or are in the process of doing so.

- Improving overall management of human resources, which the report concluded was weak and overly bureaucratic in all the countries analyzed except Thailand.

This article was first published in IRIN.