Abstract
BackgroundGlobal Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined.MethodsA multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries’ responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context.ResultsIn all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs.ConclusionSustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.
Highlights
Introduction of a NewJob/work Level of Clinical Associate
In the early 2000s the international community responded to the Human Immunodeficiency Virus (HIV) pandemic, in addition to re-emerging Tuberculosis (TB) and on-going malaria epidemics, by creating targeted disease-specific funding mechanisms, termed Global Health Initiatives (GHIs)
This paper provides an analysis of both short-term and long-term human resources for health (HRH) responses to implementation of President’s Emergency Plan For AIDS Relief (PEPFAR) and GFATM funded activities, in 5 countries in Sub-Saharan Africa (SSA)
Summary
Introduction of a NewJob/work Level of Clinical Associate. South Africa: Natinal Department of Health; 2010.29. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. In the early 2000s the international community responded to the Human Immunodeficiency Virus (HIV) pandemic, in addition to re-emerging Tuberculosis (TB) and on-going malaria epidemics, by creating targeted disease-specific funding mechanisms, termed Global Health Initiatives (GHIs) Among those funding for HIV control were the U.S President’s Emergency Plan For AIDS Relief (PEPFAR), the Global Fund for AIDS, Tuberculosis and Malaria (GFATM) and the Multicountry AIDS Program of the World Bank (MAP) [1]. This minimum threshold, which varies in relation to the epidemiological profile and the productivity of staff, was far from being achieved in most the countries in SSA at the time GHIs launched their activities
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