Yesterday UNAIDS, the WHO, and UNICEF released a particularly upbeat report on the state of HIV/AIDS prevention and control efforts globally. There were some remarkable achievements reported, including a 35% annual increase in the number of facilities providing VCTs in reporting countries, 45% coverage of PMTCT, and increased targeting of prevention services to most at risk populations. It seems as though 2008, despite the doom and gloom of the global financial crisis, was a record year for HIV efforts.
The biggest piece of news, undoubtedly, was a 1 million increase in the number of people getting access to HIV treatment globally, with the vast majority, about 80% of the gains in sub-Saharan Africa. According to the report, nearly 4 million people are now access treatment globally – 3 million in sub-Saharan African countries alone.
There has been some speculation that these numbers may represent upper bounds, or the number of people who have ever accessed treatment not those currently accessing treatment, but regardless if these numbers are anywhere close to reality, than this is a massive achievement.
But it also made me wonder about what the implications these numbers might be on human resources for health in Africa, if in fact they were correct.
Below I did a quick back of the envelope calculation of what these new treatment figures represent given best practices about human resource requirements for HIV treatment in resource poor settings. I used data from a publication by Hirschhorn et al., from what I can gather the most heavily cited figure used these days, on the numbers of doctors and nurses required to provide ART, specifically I estimated to treat 1000 people with ART it would require 2 full time doctor FTEs and 5 nurse FTEs. I then took the treatment numbers by countries from the new report and compared this to the most recent estimate of doctors in nurses in those countries from the World Health Organization and compared the numbers.
Here are my estimates for doctors:
And for nurses:
The last column in each table is my estimate of the share of the workforce that is currently being allocated to HIV treatment programs. In particular for doctors, if we believe my assumptions, we see that a massive share of the total health workforce is entirely engaged in providing ART. In some countries over 100% of the entire medical workforce would be required to treat the number of people reportedly getting access to treatment. On average, although an average here is a bit meaningless, about 25% of the doctor FTEs would be required to provide ART. The proportion for nurses is substantially lower, because Africa in general has higher numbers of nurses.
Of course assumptions like these are by nature simplifications of reality, the HRH data is a few years old, ex-pat doctors don’t generally count in the WHO figures, and there are many reasons to believe that these treatment guidelines are not being implemented optimally (either up or down). But if they are in the ballpark, and I think they might be, than it does raise some important issues regarding this massive expansion of treatment programs. Can we justify using nearly the entire health workforce in some countries to treat just one disease? What is this doing to the rest of the health sector?
I would really appreciate any comments from any readers. What are your thoughts?Share on Facebook