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Africa lacks staff to fight AIDS

5th June 2007

Severe staff shortages across several southern African nations are leading to premature deaths among those living with HIV/AIDS in the region, Paris-based humanitarian group Medicins Sans Frontieres (MSF) says.

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The agency surveyed four southern African countries - Lesotho, Malawi, Mozambique and South Africa - where MSF has operations.

It found a dire lack of healthcare workers was compromising the quality and availability of HIV/AIDS across the region. Its own programmes were also hampered for lack of staff, the group said in a statement.

For example, the survey found a clinic in Malawi where a medical assistant might see up to 200 patients a day, while patients in Mozambique were stuck on two-month waiting lists to begin treatment owing to a lack of qualified staff. Many have died waiting.

Mozambique counts only 2.6 doctors and 20 nurses for every 100,000 inhabitants, while South Africa has 74.3 doctors and 393 nurses per 100,000 inhabitants. This compares with 247 doctors and 901 nurses per 100,000 people in the United States.

Two of the countries have shown sharp falls in life expectancy as a result of the crisis. Life expectancy in Malawi is 39.7 years, while that in Lesotho is 35 years. In Malawi 170,000 people need antiretroviral treatment, but only 85,000 patients are receiving it, a gap MSF says could be made up if there were more staff to administer treatment.

Meanwhile, Lesotho has a grand total of 89 doctors to serve a population of around two million.

MSF called on government to fast track recruitment plans for healthcare workers, including improved pay and conditions. Staff numbers had often been depleted because healthcare workers had themselves contracted HIV/AIDS and died.

Even in relatively prosperous South Africa, clinics are saturated, waiting lists are growing, and healthcare professionals on the ground feel as if they are losing the battle against HIV/AIDS.

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

"It is incomprehensible that donors provide funds for life-long AIDS treatment and the building of new clinics, but refuse support for health care worker salaries on the grounds that this is 'unsustainable,'" said Sharonann Lynch, Treatment Literacy Coordinator for MSF in Lesotho. "People living with HIV/AIDS do not only need drugs and clinics; they need trained, motivated health care workers to diagnose, monitor, and treat them."

In the four countries profiled in this report, MSF is presently providing antiretroviral treatment (ART) for nearly 30,000 people. Worldwide, MSF provides ART to over 80,000 patients in more than 30 countries.

According to the report: "To compensate for the lack of doctors, Malawi relies on clinical officers and medical assistants. However, due to shortages across the spectrum of health staff, the government has created a new cadre, health surveillance assistants, who receive 10 weeks of training and are responsible for multiple tasks including: immunisation, dispensing of essential drugs, and more recently, HIV testing and counselling." However, only half the assistant posts are filled in some areas.

Part of the problem is that healthcare workers' salaries are capped by the International Monetary Fund (IMF). Salaries are based on available funds, rather than on the need for services.

Donors also shy away from allowing their funds to be used for salaries, said the report, which is entitled Help Wanted: Confronting the Health Care Worker Crisis to Expand Access to HIV/AIDS Treatment—MSF Experience in Southern Africa.



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