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

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

  • 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

    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

    • 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

    • 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

    • 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

    • 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

    • 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


    Some Cadres and Tasks


    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


    HIV Testing and Counseling

    Year


    HIV Testing and Counseling 2009


    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

    • 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

    • 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

    • 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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