Challenges for sustainable end-stage kidney disease care in low-middle-income countries: the problem of the workforce

Abstract

Prevention and early detection of kidney diseases in adults and children should be a priority for any government health department. This is particularly pertinent in the lowmiddle-income countries, mostly in Asia, Africa, Latin America, and the Caribbean, where up to 7 million people die because of lack of end-stage kidney disease treatment. The nephrology workforce (nurses, technicians, and doctors) is limited in these countries and expanding the size and expertise of the workforce is essential to permit expansion of treatment for both chronic kidney disease and end-stage kidney disease. To achieve this will require sustained action and commitment from governments, academic medical centers, local nephrology societies, and the international nephrology community.

ATTENTION: Workforce shortages as a barrier to optimal dialysis

“…The workforce problem has particular impact for sustainable ESKD care in low-middle income countries. 38 For all, deficiencies in recruiting and training qualified personnel reached crisis levels during the 2020 COVID pandemic, but were evident before it-and remain unsolved at this point. The time is now for a current workforce analysis and better development of programs to bolster the human supply chain, with a goal of expanding the workforce in order to maintain optimum care for our kidney patients.…”

“…It is likely that workforce shortages disparately impact patients disadvantaged by socioeconomic status and geographic location. The workforce problem has particular impact for sustainable ESKD care in low‐middle income countries 38 . For all, deficiencies in recruiting and training qualified personnel reached crisis levels during the 2020 COVID pandemic, but were evident before it—and remain unsolved at this point.…”

“…Countries in low and low‐middle income countries report shortages of all the categories of health care workers and support staff are the most vulnerable. Rising to meet the healthcare needs of ESKD patients around the world is an increasingly recognized challenge 38 …”

Strategic plan for integrated care of patients with kidney failure

“…Proposed activities included data capture, policy creation, definition of quality standards, evidence-based guidance, capacitybuilding, implementation, and research, as well as a performance measurement framework to assess progress. [3][4][5][6][7][8][9][10][11][12][13] In parallel, the ISN is working with the World Health Organization (WHO) to develop a technical package for those wishing to start or expand dialysis services.…”

The second Global Kidney Health Summit outputs: developing a strategic plan to increase access to integrated end-stage kidney disease care worldwide

“…5 Tonelli et al and Yang and colleagues describe a framework for establishing and developing integrated programs that address all aspects of kidney care, including ESKD, 6 and go on to present a series of 15 case studies documenting contextdriven variability in approaches to kidney care while demonstrating the potential advantages of multi-stakeholder engagement. 7 Increasing the number and expertise of trained nurses, technicians, and doctors is needed to tackle the needs for kidney care at all stages from prevention and detection to ESKD care, as shown by Swanepoel et al 8 Sola and colleagues argue for the importance of robust standards of care, standardized evidence-based guidelines, and organized oversight mechanisms to address substantial heterogeneity in practice patterns, standards, and outcomes. 9 Van Biesen and others examine the prevalent inequities in ESKD treatment provision around the world through an economic lens and discuss the need for focusing on availability, affordability, and acceptability in providing care.…”