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Antiretroviral Treatment (ART) & Human resources

Antiretroviral Treatment (ART) & Human resources. Wim Van Damme Department of Public Health ITM, 17 October 2006. Programme today. Scale-up ART in developing countries Human resources as bottleneck. AIDS = most prominent disease on political scene.

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Antiretroviral Treatment (ART) & Human resources

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  1. Antiretroviral Treatment (ART) & Human resources Wim Van Damme Department of Public Health ITM, 17 October 2006

  2. Programme today • Scale-up ART in developing countries • Human resources as bottleneck

  3. AIDS = most prominent disease on political scene

  4. AIDS = most prominent disease on political scene Why?

  5. HIV prevalence in adults in sub-Saharan Africa, 1990−2005

  6. Deaths in South-Africa(a model for of future AIDS and non-AIDS Deaths)

  7. 1980-1985 1985-1990 1990-1995 1995-2000 2000-2005 2005-2010 2010-2015 2015-2020 2020-2025 Deaths at ages 15-34South Africa: 1980-2025(Estimated and projected ) 2,000 Without AIDS 1,600 With AIDS 1,200 Deaths (thousands) 800 400 0

  8. Disease

  9. Dead

  10. Senegal Changes in life expectancyin selected African countries with high and low HIV prevalence: 1950-2005 65 60 with high HIV prevalence: Zimbabwe 55 South Africa Botswana 50 Life expectancy (years) 45 with low HIV prevalence: Madagascar 40 Mali 35 30 1950– 1955 1955- 1960 1960- 1965 1965- 1970 1970- 1975 1975- 1980 1980- 1985 1985- 1990 1990- 1995 2000- 2005 1995- 2000

  11. AIDS orphans in South Africa

  12. Orphans

  13. AIDS = political issue… Because AIDS in Southern-Africa = dramatic • Demographic impact • Economic impact • Social impact Reduction in life expectancy  “social involution” “AIDS = Unprecedented health crisis” (!! ??) “AIDS = development crisis” “AIDS = potential security threat”(??)

  14. AIDS get a lot of attention worldwide.What are the consequences?

  15. International politicalreactions to raise awareness & financial commitments International policy reactions aiming at operational results: prevention, treatment & care, impact mitigation International reactions

  16. Political reactions … leading toincreased donor funding & international Aids policies. • Donor funding • World Bank: MAP • Creation Global Fund • Private foundations: Gates & Clinton • Bush Plan (=PEPFAR) • International Aids policies • UNAIDS • WHO: ‘3-by-5’

  17. Number of people on antiretroviral therapy in low- and middle-income countries, 2002–2005 1400 1200 People receiving therapy (thousands) North Africa and the Middle East 1000 Europe and Central Asia 800 East, South and South-East Asia 600 Latin America and the Caribbean Sub-Saharan Africa 400 200 0 End 2002 Mid- 2003 End 2003 Mid- 2004 End 2004 Mid- 2005 End 2005 Source: WHO/UNAIDS (2005). Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.” 7.1

  18. People in sub-Saharan Africa on antiretroviral treatment as percentage of those in need, 2002–2005 2005 2002 2003 2004 Source: WHO/UNAIDS (2005). Progress on global access to HIV antiretroviral therapy: An update on “3 by 5.” 7.2

  19. Estimated people on ART (Dec 05)

  20. Human Resources for Health (HRH) in times of AIDS AIDS:which consequences for health staff?

  21. Who will do the job?

  22. 3 steps in HRH • HRH shortages & imbalances • Impact of AIDS on HRH • HRH needs for ART

  23. HRH shortages Source: WHO, 2004 (last update 26 Oct 2004)

  24. Impact of AIDS on HRH Increased disease burden (OIs, incl. TB, Malaria?)  Increased demand for care • More consultations • More hospitalisations • Longer hospital stays • “crowding-out effects”

  25. Increased health worker attrition & absenteeism Health workers our dying from AIDS Increased absenteeism due to own illness illness of family members funerals Consequences for the remaining carers Increased workload Compelled to work longer hours, see more patients, assume more tasks “Burn-out” Workplace security (perceived?) risk of HIV infection AIDS 

  26. Acceleration of HRH flows ??

  27. HRH crisisin sub-Saharan Africa • Absolute shortages & mal-distribution • Worsened by AIDS  workload ↑↑↑  (?) Accelerated flows & Brain drain

  28. ART = labour intensive • South-Africa: team of 11 staff for 500 patients on ART: 1 doctor, 2 nurses, 5 counsellors, … • WHO review: 5 to 7 staff for 1000 patients • Usually doctor-based models

  29. Health workers & PLWHAs(2004 data: UNAIDS & WHO)

  30. “Emergency HRH plans”TTR = treat – train - retain • Treat health workers • Investment in HRH / health systems Need for more HRH through • Training? • Retention? • Importation?

  31. Innovative solutions for ART delivery • “Task shifting”… … from MDs to clinical officers to nurses to … ‘lay providers’? Or community health workers? Simplification of treatment protocols? Group treatment?? – peer treatment?? (expert patients?) Implications: legal – financial – mentality - … “Need for a paradigm shift”??

  32. In conclusion • AIDS in high-prevalence countries = • dramatic for society • dramatic for health system • To tackle AIDS needs important investment ($/€) – but: feasible • Money = becoming available (Global Fund – PEPFAR) • But: capacity constraints: Who will do the job? •  investment needed in health system, including human resources + adaptation of treatment models

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