HIV/AIDS Workforce Development in Sub-Saharan Africa: Leveraging Opportunity for Long-Term Human Development

Abstract

Three decades into the global HIV pandemic, hindsight has become a bittersweet ally. Hindsight has shown that it is ultimately futile to address HIV/AIDS without simultaneously mounting a campaign to embolden human rights; it has taught us that the war against disease must include a battle against persistent poverty, national debt, and other structural barriers to human development; and it has demonstrated that HIV/AIDS efforts cannot and must not be developed in isolation from other health care– and health systems–related challenges, particularly in the case of resource-limited countries. Indeed, our three-decade long response to HIV/AIDS has yielded this paramount lesson: the energy, global attention, and resources that are being amassed to combat HIV/AIDS must be effectively leveraged to achieve broader progress in the areas of human rights, socioeconomic development, and public infrastructure, including ‘‘human infrastructure.’’ Too often, however, and despite our best intentions, this lesson is not effectively heeded. As a result, our programmatic response often falls into silos and/or fails to address systemic and root issues at the heart of the HIV pandemic. As a result, key opportunities are missed. There is a danger that this may again become the case with our efforts to dramatically expand the health workforce as a response to HIV/AIDS, tuberculosis, and malaria in sub-Saharan Africa and other resource-poor regions. If we wish to make a sustainable difference, without causing undue harm, we must guard vigilantly against this possibility. The challenge of scarce health human resources in subSaharan Africa is not new. This challenge predates HIV/AIDS and has preoccupied health planners, health system administrators, government leaders, academics, and other key stakeholders throughout the African continent for many decades. Scarcity of health care providers and the interconnected social, economic, and political variables that are root causes of this problem are all, themselves, epidemic in nature. From the structural adjustment policies that have forced African nations to scale back social spending, to the global poaching of developing nation physicians, nurses, and other health care providers, and now the deepening loss of health care providers to endemic diseases, African nations are all too familiar with the human resources for health challenges at hand. What is new, however, is the unprecedented global resolve—and the resources—that are currently being amassed to address this challenge as a pillar of the global HIV/AIDS response. Perhaps, the single greatest indication of this new opportunity is captured in the United States’ push to increase by 140 000 the production of health workers—physicians, nurses, and paraprofessionals—by 2013, as part of the reauthorized President’s Emergency Plan for AIDS Relief (PEPFAR). While the late stage at which this shared resolve has emerged is a testament to our continued reliance on hindsight, it nevertheless provides us a critical opportunity to improve health and human development throughout the globe. For us to realize the potential of this opportunity, however, we require innovative and carefully considered approaches and a willingness to forge new partnerships and pool resources across agencies and donor countries. We also require bold and frank discussion regarding the current capacity of academic training institutions throughout the African continent to adequately prepare physicians, nurses, and public health specialists for the health care and health management challenges posed by the HIV pandemic, in combination with other, local endemic epidemics, not to mention the delivery of primary health care. This is not to question the ability or commitment of either existing health and health care professionals or those who were charged with their training but the extent to which academic training institutions will be able to produce adequate cadres and numbers of health and health care professionals, with the appropriate skills mix necessary to address societal needs, unless there is collective resolve from the donor and technical assistance communities to help these institutions overcome