Tackling Health Workforce Shortages During Antiretroviral Treatment Scale-up—Experiences From Ethiopia and Malawi

Abstract

In many sub-Saharan countries, the health workforce shortage has been a major constraint in the scale-up of antiretroviral treatment. This human resource crisis has led to profound adjustments of the antiretroviral treatment care delivery model in several countries in the region. It also inspired some governments to take swift measures to substantially increase human resources capacity. This article draws on the experience of Malawi and Ethiopia, which have been able to successfully increase their health workforce over a relatively short period, allowing scaling up of antiretroviral treatment. Additional international HIV funding and strong political commitment made possible this exceptional response. Both countries implemented a combination of measures to tackle the human resource crisis: the delegation of medical and administrative tasks to lower health cadres and lay workers, the introduction of new health cadres, the reinforcement of pre-service training, and improving health staff remuneration. In particular, the involvement of community and lay health workers in HIV-related service delivery substantially increased the health workforce. The involvement of lay cadres has important long-term implications. To sustain results, continued political commitment, ongoing training and supervision to maintain quality of care, and strategies to avoid attrition among lay cadres will be essential. Although task shifting and involvement of lay cadres allowed bridging of the human resource gap in a short time, other strategies have to be considered simultaneously, and all interventions must be maintained over a longer period to yield results.

The global pendulum swing towards community health workers in low- and middle-income countries: a scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014

“…However, even in countries with recognized national programmes, the papers from this country, when brought together as a collection, portrayed a more diverse reality. In Ethiopia, for example, where the health extension workers (HEWs) are the recognized CHWs, at least two other community-based workers in communities were described: the community-based reproductive agents delivering contraceptive technologies [88] and community AIDS volunteers linked to NGOs and ART treatment programmes [53, 89]. Within the Health Extension Programme itself, HEWs relate to a cascade of community actors: they mobilize volunteer community health workers, also referred to as the Health Development Army, who, in turn, nominate female household members for training as “model households” [39, 90].…”

Improved Survival and Antiretroviral Treatment Outcomes in Adults Receiving Community-Based Adherence Support

“…5,7 There is a severe shortage of professional health workers in sub-Saharan African countries. [8][9][10][11] As a response to this, the number of lay health workers in ART programs has been substantially increased during the last half-decade, 12, 13 and there have been calls to further strengthen community-based adherence support (CBAS) initiatives for patients receiving ART. 14,15 To justify further resource allocation to such interventions, evidence of their effectiveness is required.…”

ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: a mixed method study

“…Limited trained health staff [12–14], lack of comfortable hospital facilities to provide ART [15, 16], shortages and unavailability of ART in certain places especially in low-income settings [17, 18], high costs, including travel, opportunity and social costs associated with ART [7, 19], are some of the most commonly cited barriers HIV+ persons face in accessing ART. Fear of side effects [20], fear of stigma and discrimination [14, 21] and lack of adequate social support [22] have also been reported as formidable barriers hindering access to ART.…”