Track E report by Anna Miller
Healthcare Workforce: Who Cares and Where?
This session explored the human workforce as a key potential bottleneck to HIV scale up. Presentations were made from global down to community level, recognising that community and nurses are there to “plug the leaks” in the prevention and care cascade: the effort of individual healthworkers result in the global data.
The Global Health Workforce Alliance presented an international perspective on human resource gaps and needs for HIV care. One billion people have no access to a skilled health worker, and the World Health Organisation estimates that 4 million additional healthworkers are needed to improve child and maternal health and treat disease like HIV and AIDS. There are complex labour market dynamics and country specific factors causing this problem but progress is possible in spite of challenges – ART coverage is going up in many of the most affected countries. Adopting evidence-based, context-specific health worker strategies will show results.
Ambassador Goosby highlighted that health workforce issues are a pressing issue for PEPFAR, with PEFPAR II (2009-2014) including health systems strengthening as a priority: the critical role of nurses and midwives is recognised in efforts to reach new targets. Strenuous efforts are being made with multiple initiatives under six objectives, towards the vision of having an appropriate number and distribution of qualified health workers who meet the HIV and other health needs of the population.
Malawi presented their experience of addressing the health workforce crisis through a comprehensive reform package funded through a SWAP (Sector Wide Approach) mechanism of basket funding, established in 2004. Impacts of the combined interventions include a substantial reduction in health worker migration, training institutions having increased enrolment and graduating numbers, an increase in health facilities meeting minimum staff norms and increases in key health service delivery indicators.
The Home Based Care Alliance (HBCA) represents a network of 30,000 caregivers across multiple countries in sub-Saharan Africa as a grassroots women-led strategy in transforming the HIV health workforce. The presenter and caregiver from Uganda gave a detailed description of the daily realities and extent of services provided to patients in their homes and an overview of strategies and challenges faced by the Alliance. There was an impassioned and well received plea for HBC givers to be formally recognised and properly supported as an integral part of the health system and as the essential force they represent in working together to end HIV and AIDS. This will require financial support from more donors / sources.
In conclusion, health workforce solutions are being developed from grassroots to global level. This includes high-level discussions on how countries can best provide a living wage to their workers, beyond temporary and non-monetary incentives. There is need to aim for an appropriate balance between quality and quantity of health workers, multi-sectoral approaches particularly between health and education sectors and long term sustainable changes in areas of recruitment, education, training and retention. At the same time, the one-to-one relationship between client and caregiver is crucial, but changing the way care is provided takes a long time. This cannot be done overnight and there is need to be patient, but all should feel empowered. The solution will not be found within one cadre of workers, with a team being needed to handle this complex illness on the ground.