Percentage of health workers with AIDS per year, Botswana

Percentage of health workers

with AIDS per year, Botswana

P

r

o

j

e

c

t

e

d

Adapted from “The Impact of HIV/AIDS on the Health Sector in Botswana”, 2000, Abt Assoc.

Demographic profiles of health personnel are required to develop more refined analyses of health

sector impacts, since risk is influenced by age, gender and geographical location. An assessment

conducted in Botswana suggests that the age profile of health workers may differ significantly from

that of the general population aged 20–64 (5). Younger health workers are migrating from the service

more than older ones and they are also dying more

from HIV/AIDS, contributing to higher attrition

from this age group.

– 4 –

Loss rates by cadre

To gain insight into the scale of need for training new staff to carry out HIV/AIDS service tasks,

information was gathered on the number of staff leaving the health services, by cadre, in a Zambia

HIV/AIDS workforce study. As shown in Table 1, losses were greatest for midwives, the cadre in

highest demand and shortest supply. In the Lusaka hospitals and clinics, loss of midwives and nurses

was particularly great, with Lusaka Trust Hospital experiencing a 60% loss rate of midwives. The

principal reason for staff losses is salary, with a large number leaving Zambia for jobs in the United

Kingdom and the United States of America. Other common reasons were transfers and death.

Although the Zambian government recently increased nurse and midwife salaries, widespread

complaints continue, so the recent salary

increase may not influence staff loss rates (6).

Table 1. HIV/AIDS staff loss rates by cadre, Zambia

Cadre

Number

currently at

work

Number who left

in last 12 months

Loss rate

Doctors 23 7 30%

Midwives 50 18 36%

Nurses 42 14 33%

Clinical officers 10 2 20%

Lab technicians 19 4 21%

Other 30 9 30%

Volunteers 31 8 26%

Total: All staff 205 62 30%

Source

: Huddart J, Furth R, Lyons J. 2004.

The Zambia HIV/AIDS workforce study: preparing for scale-up

. Quality Assurance Project,

University Research Co.,LLC.

Why are health workers absent?

Within the formal health sector, data from an assessment of health workers in Kenya and Malawi has

shown that the major reason for absences from work is related to illness. In Kenya, 34% of

absenteeism was due to personal illness and 6% to attending to a sick person (7)This was followed by

29% unknown, 17% “personal reasons,” and 14% attending funerals. In Malawi, personal illness was

similar at 38%, followed by caring for relatives (27%) (8). Kenyan health workers cited the need for

support to deal with the increased number of deaths, grief due to losing family and friends from

AIDS, and general fatigue due to work demands. They also highlighted the importance of access to counselling and psychosocial support to deal with the increased number of deaths (9).

Unfilled posts in the health sector

Due to local economic constraints and structural adjustment programmes imposed by the international

donor agencies and governance issues, many posts in developing country health systems remain

unfilled for many years. Yet, the numbers of service providers in the face of the staggering demands

imposed by the HIV/AIDS epidemic is too small to respond to the needs. In Malawi, for example,

over 64% of all nurse posts are vacant (10). A World Bank report states that Malawi faces a grave

health personnel shortage (11).

Human capital can be conserved, however, by giving

antiretroviral treatment (ART) priority to nurses,

teachers, engineers, judges, police officers and other skilled workers whose contributions are

important to economic development or social stability (12). An issue that complicates this solution is

– 5 –

that ART cannot be separated from the need for basic primary health care services, a human right for

all. Though difficult, a policy response must be developed and implemented in the context of a

comprehensive approach to enhance weak health systems.