Abstract
The Commentary on health worker migration by Mr Gostin rightly focused attention on nurses. Nurses are the backbone of primary care services in developing countries particularly Africa. The rapid expansion of human immunodeficiency virus (HIV)/AIDS and tuberculosis has resulted in a major increase in nurses workloads: in some parts of Africa HIV/AIDS has doubled the patient load for nurses with no commensurate improvement in salary or working conditions. The demands placed on nurses will likely increase with the current drive toward task shifting. Task shifting is a successful and necessary strategy to increase access to HIV/ AIDS treatment in settings with severe human resource constraints. In particular nurse initiation of antiretroviral therapy has allowed rapid expansion of treatment in settings where physicians are scarce.2 Donors are showing a keen interest in task shifting for HIV care and the Presidents Emergency Plan for AIDS Relief and World Health Organization are supporting research and implementation in this area.3 Nurses are expected both to take on new clinical responsibilities and to supervise lower cadres. Task shifting and health worker migration must be tackled together. Focusing on task shifting alone may fail because many of Africas nurses will have migrated to the United States and Europe. (full text)
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