Human resources for hiv scale up in malawi vienna 2010
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Human Resources for HIV Scale Up in Malawi Vienna, 2010 . Frank M Chimbwandira , S Makombe, E Mhango, J Njala, L Tenthani, P Moses, E Schouten, Z Chirwa, A Jahn . Malawi Indicators. 13.06 million people 12 % HIV prevalence among 15-49 year olds About 1 million PLWH

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Human Resources for HIV Scale Up in Malawi Vienna, 2010

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Human resources for hiv scale up in malawi vienna 2010

Human Resources for HIV Scale Up in Malawi Vienna, 2010

Frank M Chimbwandira,S Makombe, E Mhango, J Njala, L Tenthani, P Moses, E Schouten, Z Chirwa, A Jahn


Malawi indicators

Malawi Indicators

  • 13.06 million people

  • 12 % HIV prevalence

    • among 15-49 year olds

  • About 1 million PLWH

  • 384 000 in need of ART

    • 211 246 PLHIV alive and on ART by March, 2010

  • Approx. 700 000 orphans due to AIDS epidemic

  • 1 Physician : 49 000 people

  • 1 Nurse :1 800 people


  • Human resources for health i

    Human Resources for Health I

    Malawi situation in 2004:

    64% vacancies among nurses;

    Over half of 29 districts have less than 1.5 nurses per facility, and five districts have less than one

    53% vacancies among clinical officers;

    85%-100% vacancies among specialists

    10 districts without a MoH doctor, four districts without any doctor at all


    Human resources for health ii

    Human Resources for Health II

    • In 2004 Dr Peter Piot (UNAIDS) and Dr Suma Chakrabarti (DFID) were concerned

      “ ….. that without a substantial increase in health workers, it would not be possible [for Malawi] to roll out antiretroviral treatment without further undermining the already weak health system.”

      Palmer D, ………

      Reproductive Health Matters 2006; 14(27):27-39…………


    Human resources for health iii

    Human Resources for Health III

    • Inadequate workforce in the health delivery system was aggravated by

      • Poor recruitment systems

      • Limited or non-responsive trainings

      • Poor staff retention mechanisms

      • Inadequate finances


    Emergency hrp i plan

    Emergency HRP I: Plan

    • Drawn up for 2004 – 2010 period

    • Focused on retention, deployment, recruitment, training and tutor incentives

    • Targeted 11 cadres

      • Physicians, nurses, COs, MAs, pharmacists, lab technicians, … and expansion of community health worker cadres

    • Budget: ~US$200 m  US$270 m

      • GoM, DFID, GFATM, Health SWAp ……


    Emergency hrp ii approaches

    Emergency HRP II: Approaches

    • Short-term interventions

      • Recruit unemployed or retired staff

      • Expatriate staff for TA and mentoring

      • Salary top-ups

      • Recruitment of community health workers

    • Long-term interventions

      • In-country pre-service training

      • Comprehensive Monitoring and Evaluation Systems


    Emergency hrp iii outcomes i

    Emergency HRP III: Outcomes I

    • More posts were filled between 2003 and 2007

      • 30% increase in nurses, 40% in medical doctors, and 50% in clinical officers

    • Reduced emigration of nurses

    • Over 5600 community health workers were recruited

    • Training institutions created more room for enrollment: infrastructure development


    Emergency hrp iv outcomes ii

    Emergency HRP IV: Outcomes II


    Some cadres and tasks

    Some Cadres and Tasks


    Art scale up malawi

    ART Scale Up: Malawi

    2009

    Sites : 377

    Alive: 198,846

    Coverage: 53%

    2006

    Sites: 141

    Alive: 59,980

    Coverage: 17%

    2003

    Sites: 9

    Alive: ??

    Coverage: ??

    2008

    Sites: 221

    Alive: 147,497

    Coverage: 41%

    2007

    Sites: 163

    Alive: 100,649

    Coverage: 28 %

    2004

    Sites: 24

    Alive: 10,761

    Coverage: 3%

    Doctors and Clinical Officers (COs)

    Doctors , Clinical Officers, Medical Assistants (MAs)

    Doctors, COs, MAs and Nurses

    Policy Changes: Who should initiate ART? >………………..


    Art sites in malawi

    ART Sites In Malawi


    Hiv testing and counseling

    HIV Testing and Counseling

    Year


    Hiv testing and counseling 2009

    HIV Testing and Counseling 2009


    Htc scale up

    HTC Scale Up

    • Approaches

      • Door-to-Door HIV testing and Counseling

      • National HTC Campaigns

        • HTC weeks, targeted sites or functions

      • Mobile and Outreach HTC

      • Task shifting:

        • Health Surveillance Assistants do HTC

      • Task sharing:

        • Provider Initiated Testing and Counseling


    Challenges

    Challenges

    • Need for more workforce

      • Increasing number of clients on ART

      • Implementation of new WHO ART/PMTCT guide

      • Task shifting has a limit: HSAs may not initiate ART nor follow up clients

    • Central posts need strengthening

      • Eg Central Medical Stores & technical posts

    • Donor-dependence on staff retention:

      • TAs, Salary top ups ….


    Plans

    Plans

    • New Programme of Work/SWAp

      • Under discussion with donors, HR still

    • Decentralise HIV services

      • Opening of more clinics

      • Engage expert patients through support groups

      • Strengthen Integration of HIV services

    • Use of new and better regimens (in ART)

      • Triomune  Atripla from 2011


    Conclusions

    Conclusions

    • HR will determine further scale up of HIV services including implementation of the new adopted WHO ART/PMTCT Guidelines.

      • Training of more personnel (Physicians, COs, nurses and MAs) still remains an option for Malawi

    • Sustainable retention mechanisms are essential too.


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