Will Universal Access to Antiretroviral Therapy Ever be Possible? The Health Care Worker Challenge

Abstract

The United Nations millennium development goal of providing universal access to antiretroviral therapy (ART) for patients living with HIV/AIDS by 2010 is unachievable. Currently, four million people are receiving ART, of an estimated 13.7 million who need it. A major challenge to achieving this goal is the shortage of health care workers in low-income and low-resource areas of the world. Sub-Saharan African countries have 68% of the world's burden of illness from AIDS, yet have only 3% of health care workers worldwide. The shortage of health care providers is primarily caused by a national and international 'brain drain,' poor distribution of health care workers within countries, and health care worker burnout.Even though the millennium development goal to provide universal access to ART will not be met by 2010, it is imperative to continue to build on the momentum created by these humanitarian goals. The present literature review was written with the purpose of attracting research and policy attention toward evidence from small-scale projects in sub-Saharan Africa, which have been successful at increasing access to ART. Specifically, a primary-care model of ART delivery, which focuses on decentralization of services, task shifting and community involvement will be discussed. To improve the health care worker shortage in sub-Saharan Africa, the conventional model of health care delivery must be replaced with an innovative model that utilizes doctors, nurses and community members more effectively.

Lay Health Workers and HIV Care in Rural Lesotho: A Report from the Field

“…Given observed and projected economic limitations to achieving adequate health professional staffing exacerbated by the AIDS epidemic, 35,36 the LHWs provide an approach to help address the health worker gap in poor, rural settings. 37 Although not a replacement for nurses and other professionals, we found that LHWs extended the reach of clinic professional staff and were a relatively rapid and economical solution to staffing shortages. Since LHWs are local staff, they do not require housing at the remote, rural health facilities.…”

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.…”

Healthcare worker safety: a vital component of surgical capacity development in low-resource settings

“…Sub-Saharan Africa carries 68% of the world’s HIV/AIDS burden but has only 3% of healthcare workers worldwide and 1% of financial resources for health. 16,17 Surgical disparities are even more profound, and Rwanda is no exception, with less than 0.5 total surgeons per 100 000 persons. 15 Given the scarcity of surgical personnel in Rwanda, healthcare worker safety should be a priority.…”