Abstract
BackgroundThe lack of human resources for health (HRH) is increasingly being recognized as a major bottleneck to scaling up antiretroviral treatment (ART), particularly in sub-Saharan Africa, whose societies and health systems are hardest hit by HIV/AIDS. In this case study of Swaziland, we describe the current HRH situation in the public sector. We identify major factors that contribute to the crisis, describe policy initiatives to tackle it and base on these a number of projections for the future. Finally, we suggest some areas for further research that may contribute to tackling the HRH crisis in Swaziland.MethodsWe visited Swaziland twice within 18 months in order to capture the HRH situation as well as the responses to it in 2004 and in 2005. Using semi-structured interviews with key informants and group interviews, we obtained qualitative and quantitative data on the HRH situation in the public and mission health sectors. We complemented this with an analysis of primary documents and a review of the available relevant reports and studies.ResultsThe public health sector in Swaziland faces a serious shortage of health workers: 44% of posts for physicians, 19% of posts for nurses and 17% of nursing assistant posts were unfilled in 2004. We identified emigration and attrition due to HIV/AIDS as major factors depleting the health workforce. The annual training output of only 80 new nurses is not sufficient to compensate for these losses, and based on the situation in 2004 we estimated that the nursing workforce in the public sector would have been reduced by more than 40% by 2010. In 2005 we found that new initiatives by the Swazi government, such as the scale-up of ART, the introduction of retention measures to decrease emigration and the influx of foreign nurses could have the potential to improve the situation. A combination of such measures, together with the planned increase in the training capacity of the country's nursing schools, could even reverse the trend of a diminishing health workforce.ConclusionEmigration and attrition due to HIV/AIDS are undermining the health workforce in the public sector of Swaziland. Short-term and long-term measures for overcoming this HRH crisis have been initiated by the Swazi government and must be further supported and increased. Scaling up antiretroviral treatment (ART) and making it accessible and acceptable for the health workforce is of paramount importance for halting the attrition due to HIV/AIDS. To this end, we also recommend exploring ways to make ART delivery less labour-intensive. The production of nurses and nursing assistants must be urgently increased. Although the migration of HRH is a global issue requiring solutions at various levels, innovative in-country strategies for retaining staff must be further explored in order to stem as much as possible the emigration from Swaziland.
Highlights
The lack of human resources for health (HRH) is increasingly being recognized as a major bottleneck to scaling up antiretroviral treatment (ART), in sub-Saharan Africa, whose societies and health systems are hardest hit by HIV/AIDS
In many countries of sub-Saharan Africa, people with HIV-related illnesses occupy more than 50% of hospital beds and there is abundant evidence that health workers are overwhelmed by the demand for care [2,3]
Summary of findings Our findings from June 2004 showed that the public health sector in Swaziland was losing its health workers at an alarming rate
Summary
The lack of human resources for health (HRH) is increasingly being recognized as a major bottleneck to scaling up antiretroviral treatment (ART), in sub-Saharan Africa, whose societies and health systems are hardest hit by HIV/AIDS. We identify major factors that contribute to the crisis, describe policy initiatives to tackle it and base on these a number of projections for the future. The Joint Learning Initiative estimates that: "sub-Saharan countries must nearly triple their current numbers of workers by adding the equivalent of one million workers [...] if they are to come close to approaching the Millennium Development Goals for health" [1]. The lack of health workers in sub-Saharan Africa is regarded by many as the key bottleneck for scaling up antiretroviral treatment (ART) for the millions in need of it [2,4,5]
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