Healio
Healio
Issue: October 2008
October 01, 2008
5 min read
Save

Health care worker shortage may be exacerbating HIV/AIDS epidemic

Thirty-six countries in sub-Saharan Africa have fewer than 2.3 health care professionals per 1,000 citizens.

Issue: October 2008

There may be as many as 4.3 million too few health care workers throughout the world, according to estimates from WHO.

In many parts of the world, the shortage of health care workers — including doctors, nurses, pharmacists, community health workers, lab technicians, physician assistants and mental health workers — often prevents patients from receiving appropriate care and treatment. There is a widespread belief that the health care worker shortage is playing a role in furthering the spread of some of the most severe infectious diseases, particularly HIV/AIDS.

Officials from WHO have determined that there should be a minimum of 2.3 doctors, nurses and midwives for every 1,000 citizens of a country. According to WHO officials, nations where the number of doctors, nurses and midwives is below this threshold are “very unlikely” to reach the health-related Millennium Development Goals, of which halting and reversing the spread of HIV/AIDS is a major component.

Worldwide, 57 countries are below the threshold of 2.3 doctors, nurses and midwives for every 1,000 citizens; 36 of these countries are in sub- Saharan Africa.

Sub-Saharan Africa

The shortage is most apparent in sub-Saharan Africa. Most of the countries with health care worker shortages are in this region, and the shortages here are often more acute than in other countries with shortages. Sub-Saharan Africa is home to about 3% of the world’s health care workers, but, according to WHO estimates, 24% of the global disease burden is found in this region. This is also the region hardest hit by the HIV/AIDS epidemic.

According to WHO estimates, there is a shortage of more than 800,000 doctors, nurses and midwives in sub-Saharan Africa. Extent of the shortage varies by country, but the shortage is often most severe in nations that have been most affected by the HIV/AIDS epidemic. For example, the rate of doctors, nurses and midwives per 1,000 citizens is 0.25 in Ethiopia, 0.36 in Mozambique, 0.61 in Malawi and 0.79 in Uganda.

The nation with the gravest shortage is Ethiopia, where there are about three doctors for every 100,000 citizens. To equate this with an American locale, this would be comparable with having 17 doctors for the entire city of Washington, D.C.

The shortage is also typically more apparent in rural areas. Although shortages exist in urban areas of sub-Saharan Africa, health care workers are often more likely to work and live in urban areas. This furthers the burden for patients in rural areas, many of whom may have to travel to urban areas for care or go without care.

Role in HIV/AIDS epidemic

Eric Friedman, JD, senior global health policy advisor at Physicians for Human Rights, has been involved with the health care worker shortage issue for many years. Friedman recently co-authored a guide detailing Physicians for Human Rights’ stance that access to health care is a fundamental human right and that this right is compromised for many people living in areas where there is a shortage. The guide also details how all countries can build human rights into health workforce planning. Friedman and several colleagues released this guide at a press conference at the XVII International AIDS Conference, held recently in Mexico City.

In an interview with Infectious Disease News, Friedman said the shortage has had a particularly devastating effect on patients with HIV/AIDS. “Treatment for HIV/AIDS is often very health care worker–intensive,” Friedman said. “When there is a shortage of health care workers, it is an obstacle in ensuring treatment for patients. Patients are less likely to see a health care worker and when they do, the quality of care is affected because the health care worker typically has less time to spend with them.”

Friedman said that HIV/AIDS testing and prevention is also affected by the shortage. “With fewer health care workers, there are fewer people able to test the population, which is an important aspect of fighting HIV/AIDS,” Friedman said. “Also, people are less likely to come to a clinic for testing if there are long lines and little time with a health care worker.”

Friedman also said the shortage hurts efforts to integrate HIV/AIDS care with other forms of health care. “When there is a shortage of staff members, already overburdened health care workers may be limited in their ability to take on new HIV/AIDS tasks,” Friedman said. “Opportunities to diagnose and treat patients are lost. NGOs may find it easier to establish separate AIDS programs – which can draw health workers away from providing other forms of health care – rather than work within the existing public health infrastructure.”

Causes of the shortage

The health care worker shortage has several causes. One causative factor is that many developing countries are lacking educational programs to adequately train people to become doctors, nurses and other health care workers. Underfunding for the health care sector in many countries has further perpetuated this problem.

The risks of health carwe work also further the shortage. In many parts of the world, health care workers are at an increased risk for contracting or dying of an infectious disease. Fear of contracting HIV/AIDS or other infectious diseases has steered people away from seeking jobs as health care workers in many parts of the world. In countries hardest hit by HIV/AIDS, death from complications related to AIDS is a chief cause of health worker attrition.

Finally, “brain drain” – the emigration of health care workers to wealthier countries – has extended the shortage in many of the world’s poorest nations.

Public health advocates and health care workers from around the world are now banding together to demand greater support in the fight against the global shortage.

The recent efforts of Physicians for Human Rights are intended to encourage more countries to address the shortage. “We need a comprehensive approach to address the health care worker shortage,” Friedman said. “It is imperative that human rights–based health care worker plans are fully funded in every country. Our goal is to help countries develop these plans and implement them.”

Friedman mentioned that the new U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is an important step in addressing the issue. The new PEPFAR goes further in addressing the issue than any previous piece of legislation. Friedman and Physicians for Human Rights will work to ensure the optimal benefits are realized from PEPFAR. “One of our goals is to ensure that the new PEPFAR plans are well implemented,” he said. “The new PEPFAR includes a pledge to help train at least 140,000 new health care workers, the largest commitment of any donor today. This needs to be effectively implemented to ensure its benefits in many countries hardest hit by the health care worker shortage.”

Paul Davis, director of U.S. government relations for Health Gap, agreed that the new PEPFAR could have far-reaching benefits in countries where there is a shortage. “The HIV/AIDS epidemic is a global health crisis and we need many more health care workers to respond to it on the front lines,” Davis told Infectious Disease News

. “The new PEPFAR is a new commitment to fight HIV/AIDS with a new round of investments, including more health care workers and health care facilities.”

Davis said he believes addressing the shortage is now the most imperative issue in fighting the global HIV/AIDS epidemic. “The single thing we cannot do is go another step forward without resolving the deadly shortage of health care workers,” he said. “We must work with all countries to maintain and train health care workers to continue the fight against HIV/AIDS.” – by Jay Lewis

For more information: