Investing in the health workforce to increase access to and use of HIV and AIDS services in Uganda.

Abstract

Despite progress over the last decade, Uganda's achievement of key health indicators, including for HIV and AIDS, remains unsatisfactory and continues to represent leading causes of morbidity and mortality [1]. As the Government of Uganda works to improve healthcare across all service delivery areas, HIV and AIDS receives heightened attention because of the country's ranking in terms of the number of new HIV infections, people living with HIV (PLHIV), AIDS-related deaths, and adult HIV prevalence rate [2]. Intensive efforts in HIV prevention, care, and treatment led to a decrease in HIV prevalence from a high of 18% in the 1990s to 6.4% in 2002. After persisting at this level from 2002 to 2007, HIV prevalence rose to a national average of 7.3% (2011) [3,4]. Many regions experience an even higher burden of HIV, especially in central and mid-northern Uganda, with prevalence ranging from 8.3 to 10.6% [4]. Health workforce challenges undermine HIV service delivery Uganda's aim to strengthen and scale up its HIV and AIDS response to reduce new infections and achieve ‘a population free of HIV and its effects’ [5] is undermined by low utilization of health services and perceived low quality of healthcare [6]. A key element of quality service delivery and demand is a well performing and well trained health workforce [7]. Uganda's absolute shortage and inadequate geographic distribution of health workers with appropriate skill mix to provide services across the continuum hinders achievement of epidemic control. A national staff audit conducted by the Ministry of Health in 2009 found that 47% of established positions in government health facilities were vacant [8]. In addition, about 71% of doctors and 41% of nurses and midwives were working in urban areas, although 85% of the population reside in rural areas [9,10]. Factors contributing to high health worker vacancy and low retention include weak leadership and management, inadequate planning and human resources management systems, low levels of motivation, and poor working and living conditions in rural areas [6]. To address health workforce challenges affecting quality of care for HIV and AIDS, the United States Agency for International Development (USAID) and U.S. President's Emergency Plan for AIDS Relief-funded global CapacityPlus project and bilateral Uganda Capacity Program (UCP), both led by IntraHealth International, worked in close collaboration with the Ministry of Health to strengthen health workforce management to enable improved delivery of quality HIV and AIDS services. They also provided family planning, reproductive health and other health services with funding from PEPFAR and USAID's Population and Reproductive Health, Maternal and Child Health, and other programs. This field note describes selected interventions from a more comprehensive package of human resources management support provided to the Ministry of Health, to improve the utilization of data for evidence-based planning, deployment, and management of the health workforce. It also provides an example of how health workforce data can be analyzed alongside country-level HIV service statistics to ensure an adequate supply of human resources for health (HRH) where increased accessibility and scale-up of HIV services is needed to achieve 90–90–90 goals [11–13].