HIV/AIDS

The following guidelines have been developed by a working group of practitioners drawn from clinics, hospitals, congregations and communities. They are intended for use by practitioners from the congregation, community, clinic, and other partners in local responses which are incorporating ART. [Description from preface]

The lack of human resources for health (HRH) is increasingly being recognized as a major bottleneck to scaling up antiretroviral treatment (ART), particularly in sub-Saharan Africa, whose societies and health systems are hardest hit by HIV/AIDS. In this case study of Swaziland, we describe the current HRH situation in the public sector. We identify major factors that contribute to the crisis, describe policy initiatives to tackle it and base on these a number of projections for the future. Finally, we suggest some areas for further research that may contribute to tackling the HRH crisis in Swaziland.

Efforts to increase access to life-saving treatment, including antiretroviral therapy (ART), for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers.

A number of ART projects are trying to tackle the HRH problematic by delegating certain tasks from medical doctors to other cadres. While this task-shifting is certainly an important step, we contend that it will not be enough for scaling up ART in the high HIV-prevalence countries with the most severe HRH shortages. In the present report we argue that an altogether different approach to HIV/AIDS care and treatment might be required for overcoming the HRH bottleneck. [from summary]

Triple-drug combination antiretroviral (ARV) therapy has yielded remarkable results in affluent countries and some middle-income countries such as Brazil. Lessons can be learned from these examples, but this publication reviews the experiences of ARV programmes already underway in countries with very severe HIV epidemics but severely constrained resources, as in most of Africa and part of the Caribbean. The publication aims to show how some of the key policy issues for scaling up HIV/AIDS treatment have been dealt with and to identify common elements that should be considered by everyone seeking to provide HIV/AIDS care on a significant scale.

The human capacity-building plan proposes a set of products and services supporting countries in their efforts to plan for, train and sustain the human capacity to achieve 3 by 5.

The HRM-HIV Tool provides organizations with a participatory, rapid assessment tool for identifying an organization’s human resource management status and making concrete plans for improvements within HIV/AIDS environments. It has been used with both public and private organizations in Ghana, Kenya, Nigeria, and Tanzania. The tool conforms to principles of participation and self-determination that guide all of MSH’s training and technical assistance activities. [author’s description]

This WHO strategy aims to set out in clear detail how life-long antiretroviral treatment can be provided to 3 million people living with HIV/AIDS in poor countries by the end of 2005. Core principles include urgency, equity and sustainability. HIV/AIDS has devastated the populations and health services of many developing countries. We must act now. Further, since this magnitude of scaling up HIV/AIDS treatment has never been attempted before, we must learn by doing. [summary from author]

This paper describes three examples of human resource development in community-driven HIV/AIDS programmes. The basic proposition is that acknowledgement, inclusion of and support for community based health initiatives is necessary to understand fully where health action is occurring and where potential for expansion lies. The paper calls for an expanded definition of health systems encompassing work being carried out by communities who are at the frontline in responding to the HIV/AIDS epidemic. Health care workers live in communities, and communities are providing health care.

Results of a study of human resources and antiretroviral therapy (ART) at 41 sites in 11 countries, presented in three sections: an overview of service delivery models for ART, a more in-depth account of the systems studied and a report of an international workshop on HRH and ART delivery.

This background paper aims to increase understanding of the requirements for introducing and scaling up provision of antiretroviral therapy (ART) as part of comprehensive HIV/AIDS programmes in resource-poor countries. The paper provides an overview of experience and lessons learned with regard to: the feasibility of ART in resource-poor settings; the different approaches being taken to delivery of ART; and the issues to be considered in scaling up ART provision, including human resources. [adapted from author]

Over the past few years, a united battle against HIV/AIDS has gained momentum worldwide. Non-governmental and community-based programs, national and international organizations—all are confronting the myriad of challenges posed by the HIV/AIDS pandemic. In an effort to provide policymakers, technical personnel, and other stakeholders comprehensive information on the costs of interventions and the impact of HIV/AIDS on health systems, PHRplus has prepared this annotated bibliography. The documents described focus on those aspects of the pandemic most related to the work of the project issues of economic impact, financing and resource allocation, costing, health system strengthening, scaling up antiretroviral therapy, surveillance systems, and program monitoring and evaluation.

This toolkit includes a collection of HRM resources and links assembled for the Global Health 2005 conference. Most of the resources are in Microsoft Word format and provide guidance on how to develop a variety of HRM documents or processes. Topics covered include supervision, hiring and recruitment, HR policies, and HIV Workplace Programs and training. [publisher’s description]

No satisfactory strategy for reducing high child mortality from malaria has yet been established in tropical Africa. The authors compared the effect on under-5 mortality of teaching mothers to promptly provide antimalarials to their sick children at home, with the present community health worker approach. The study concludes that a major reduction in under-5 mortality can be achieved in holoendemic malaria areas through training local mother coordinators to teach mothers to give under-5 children antimalarial drugs. [adapted from abstract]

The overall objective of this paper is to provide some insights into the effects of the HIV epidemic on human capital in sub-Saharan Africa through a discussion of some of the factors that are operating. It is not intended as a compendium of data on the problem but aims instead to provide an analytical framework for understanding the policy and programming issues. There is an analysis of the impact on the public services in Malawi, a detailed presentation of the impact on education and health and a discussion of issues relating to the measurement of the impact on different productive sectors and the role of different social partners in adjusting to, and managing, the impact.

The WHO IMAI guidelines support the rapid expansion of access to ART by supporting the shifts of key tasks to multi-purpose health workers at first-level facilities located in the community (health centres and clinics). By preparing nurses and clinical aids to provide acute care to adults, many opportunistic infections can be treated and the patient stabilized for ARV treatment without referral to district clinic. Management of patients near their home is important for equity and to achieve high levels of ARV adherence. [adapted from publisher’s description]

Countries in the Europe and Eurasia region are facing a significant and expanding HIV/AIDS epidemic that is largely concentrated among particularly vulnerable populations. A window of opportunity exists to respond effectively to the epidemic and to halt its spread, both within and beyond vulnerable populations. However, available evidence indicates that this opportunity is being missed. One explanation for this is that significant barriers exist within the region’s health systems that prevent rapid scale–up of effective HIV/AIDS programs.

This study seeks to examine these barriers and ways they can be overcome.

This report emanates from the results of a study that examined the impact of HIV/AIDS on the public and private health facilities in South Africa, and outlines the subsystems that are affected. Both public and private sector health facilities have reported an increase in the number of patients seeking clinical care for people living with HIV/AIDS, leading to increased admissions to medical and pediatric wards and increased workloads. This study addresses these issues and makes recommendations for managing the HIV/AIDS case load. [from author]

Action is underway to increase access to antiretroviral drugs, especially in countries with high rates of HIV. The role of private providers is largely ignored, although they are an important source of care for stigmatizing diseases in many poor countries. Evidence is emerging that antiretroviral drugs are leaking into formal and informal private markets. Uncontrolled use of drugs in the private sector will lead to rapid development of HIV resistance. Countries require guidance and support from international policy makers and pharmaceutical companies to implement strategies for working with private providers.

Four articles by separate authors on institutional responses and policies for managing HIV/AIDS in Africa, with specific emphasis on the role of tertiary institutions, such as schools and colleges. The articles are not specific to health training institutions, but are relevant to this context.

This study examines the attitudes of nursing students toward caring for HIV/AIDS patients and their knowledge and perceptions about the disease. Findings revealed a very positive outlook of the nursing students in regards to caring for HIV/AIDS patients. Although most of them expressed their willingness to take any job offer concerning caring for HIV/AIDS patients, 34.3% apprehended resistance from their family members in this regard. However, they also considered that it would be possible for them to overcome the resistance. Although 100% of the students had heard of HIV/AIDS, a number of them had misconceptions about various aspects of the disease.

This paper reviews data, studies, and other information on HIV/AIDS impacts on human resources in sub-Saharan Africa. The purpose is to guide the development of an instrument to conduct HIV/AIDS human resource assessments in the health sector. Until now, inadequate attention has been devoted to this critical step in responding to the epidemic. Such assessments can assist policy makers and advocacy groups to shape and accelerate the implementation of national HIV/AIDS policies and programs throughout the continent. [Description from author]

Every year a million women infected with HIV deliver babies without professional help. This article suggests that traditional birth attendants could be involved in preventing perinatal transmission of HIV by offering services such as HIV testing and counseling and short courses of antiretroviral drugs. [publisher’s description]

This news article introduces an approach to HIV/AIDS treatment that has helped Uganda scale up treatment in the midst of limited health workers. The approach, called Integrated Management of Adult and Adolescent Illness (IMAI), has been inspired by successes in Latin America, the former Soviet Union and Africa, where lay health workers who are often relatives, friends or other community volunteers have been trained to help treat tuberculosis patients in poor settings. [adapted from author]

This report presents the findings of a study conducted at 16 healthcare sites in Zambia offering voluntary counseling and testing (VCT), prevention of mother-to-child transmission of HIV (P-MTCT), and antiretroviral (ARV) therapy. The study period, including design, implementation, and data analysis, was April to June 2003. The purpose of the study was to assist the Government of Zambia in determining whether it will have sufficient staff to be able to scale up VCT, P-MTCT, and ARV treatment to reach its targeted numbers of clients.

We are beginning to recognize that, parallel to biological action, the HIV/AIDS pandemic also attacks the human capacity and social defence systems. By destroying the fabric of health systems, the spread and impact of the epidemic is hugely augmented. [author’s description]

The challenge of tackling HIV/AIDS was taken up by African Heads of State at their summit in Abuja in 2001. This led to the Abuja Declaration, the primary goal of which is to reverse the accelerating rate of HIV infection, TB and other related infectious diseases.

This report is based on research carried out by ActionAid International in Kenya, Malawi, Nigeria and Zimbabwe and provides a comparative analysis of the achievements and challenges faced by these four African countries in relation to the Declaration. [Adapted from author]

What effect does the increased number of Malawians living with HIV/AIDS have on the public health sector? To address this question, the Commonwealth Regional Health Community Secretariat (CRHCS) and Malawian researchers from the Ministry of Health and Population (MoHP), with support from the U.S. Agency for International Development, Bureau for Africa, undertook an assessment to explore the effects of HIV/AIDS on the health workforce. [author’s description]

This report, written for the World Summit on Sustainable Development, Johannesburg 2002, discusses the impact of HIV on the workforce and calls for governments to live up to the benchmark of action agreed to in the 2001 Declaration of Commitment to HIV/AIDS.

This paper summarizes the key issues confronting human resources (HR) in the health sector in sub-Saharan Africa and the role that HIV/AIDS has played in exacerbating this crisis. Section I reviews the causes and consequences of this crisis. Section II focuses on the effects of the HIV/AIDS epidemic on the crisis. Section III analyzes the constraints faced by recent health initiatives in addressing HR issues. Finally, Section IV provides recommendations on how donors and other partners can address HR issues in a more intensive, sustained, and concerted manner. [summary]