HIV :: Health workers & doctors shortage limits AIDS care in South Africa

A severe lack of healthcare workers is compromising both quality and availability of HIV/AIDS care in southern Africa, warned international medical relief organisation Medecins Sans Frontieres (MSF).

In a new report exploring the situation in Lesotho, Malawi, Mozambique and South Africa, MSF said more than 1 million people were in need of antiretroviral (ARV) drugs in each of these countries but could not accessing them.

Rachel Cohen, the MSF head of mission in Lesotho, attributed part of the problem to treatment expansion efforts in the region, which was leading to staff migration to countries that offered better pay and more manageable workloads.

“In Thyolo district we are treating 7,000 people with HIV/AIDS. We need to increase this number to 10,000 by the end of the year, but our program is hitting a wall because there are simply not enough nurses, doctors and medical assistants,” said Veronica Chikafa, a nurse/matron working with MSF in Malawi.

Severe shortages of health staff are compromising the quality and availability of HIV/AIDS care across southern Africa. In Thyolo district in Malawi, a medical assistant can see up to 200 patients per day, far too many to ensure quality care. In Mavalane district in Mozambique, patients are forced to wait for up to two months to start treatment because of the lack of doctors and nurses, and many have died during the wait.

In Lesotho there are only 89 doctors in the whole country. “Providing HIV care in rural clinics depends on nurses, but they are overwhelmed by the number of patients,” said Dr Pheello Lethola, field doctor for MSF in Lesotho. “Consultation times are too short, and sick patients suffer needlessly. When nurses suffer, patients suffer.”

There is wide acknowledgement of the human resource crisis, but little action on the ground. MSF is urging governments to develop and implement emergency plans to retain and recruit health care workers that include measures to raise pay and improve working conditions. In most countries this will only happen if donors change their policies and start providing financial support for recurrent costs such as salaries. Ministries of finance and the International Monetary Fund (IMF) will need to find solutions to overcome “caps” on the number of health workers and level of salaries. Otherwise, governments will not be able to respond adequately to the unmet need for treatment.

Even in South Africa, which has more health care workers who are better paid compared to other southern African countries, unequal distribution and inadequate numbers of staff are causing delays to expanding treatment. “Clinics are absolutely saturated, waiting lists are growing, and it feels like we are losing the battle,” said Dr. Eric Goemaere, head of MSF’s program in Khayelitsha, Western Cape. “For people making policies in offices far away from patients, our message is that you will be held responsible if you are not reactive or flexible enough to find solutions to the staff shortages.”

To expand access to HIV care in rural settings, MSF teams have relied on “task-shifting” from doctors to nurses, and from nurses to community workers. But these are limited measures that do not remove the need for additional skilled staff.

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