Aug 15 2006
The World Health Organization (WHO), in collaboration with the International Labour Organization and the International Organization for Migration, today announced the launch of a coordinated global plan to address a major and often overlooked barrier to preventing and treating HIV/AIDS: the severe shortage of health workers, particularly in developing nations.
Called 'Treat, Train, Retain', the plan is an important component of WHO's overall efforts to strengthen human resources for health and to promote comprehensive national strategies for human resource development across different disease programmes. The plan is also part of WHO's work to promote universal access to HIV/AIDS services. Through its HIV/AIDS Programme, WHO is playing a central role in making the goal of universal access a reality.
Fifty-seven countries, mostly in sub-Saharan Africa and Asia (particularly Bangladesh, India, and Indonesia) face crippling shortages of health workers. WHO estimates that more than four million health workers are needed to fill the gap. Sub-Saharan Africa faces the greatest challenges. With 11 percent of the world's population and almost 64 percent of all people living with HIV, the region has only 3 percent of the world's health workers. Globally, health workers are also concentrated in urban areas, leaving shortages in rural areas.
In sub-Saharan Africa and elsewhere, the HIV/AIDS epidemic is contributing to health worker shortages. HIV/AIDS is an emerging source of mortality, loss of productivity and demoralisation among health workers. HIV/AIDS also has changed the way young people view health work, making it a less desirable career choice and leading to a lack of health workers trained to prevent and treat AIDS. In addition, many health workers trained in developing world health systems leave their jobs (or countries) for better-paying jobs in wealthy countries, in bigger cities or at non-governmental organizations (NGOs).
"WHO has a unique role to play in helping countries mount an effective, comprehensive and sustainable response to the AIDS epidemic," said Dr. Anarfi Asamoa-Baah, Assistant Director-General of WHO. "The shortage of health workers is devastating public health systems, particularly in the developing world, and it is one of the most significant challenges we face in preventing and treating HIV. WHO is launching 'Treat, Train, Retain' to confront this crisis."
"WHO's 'Treat, Train, Retain' plan provides a much-needed boost to national health systems that will have an impact far beyond HIV/AIDS," remarked Dr Sigrun Mogedal, the Norwegian government's Ambassador for HIV/AIDS. "By increasing the number of well-trained, healthy and motivated health workers, the plan will provide significant benefit to health systems generally."
The 'Treat, Train, Retain' plan will be implemented under the umbrella of the Global Health Workforce Alliance, hosted by WHO, which was established in May 2006. The Alliance is a partnership of governments, aid agencies, civil society groups and multilateral organizations.
"'Treat, Train, Retain' draws on the growing body of evidence and experience of what works in improving the performance of the health workforce," said Dr Francis Omaswa, Executive Director of the Global Health Workforce Alliance. "It will accelerate the adoption of best practices on critical issues like the increased roles and responsibilities of community health workers in combating HIV/AIDS and promoting better health at household and community level."
'Treat, Train, Retain' will focus on those countries most severely affected by HIV/AIDS, and incorporates a menu of options that countries can adapt to their specific needs. WHO estimates that it will cost a minimum of US$7.2 billion over the next five years to implement the plan in the 60 countries with the highest HIV burden, and it could cost substantially more – up to US$14 billion. This corresponds to an annual per capita cost of approximately US$0.60 in the countries concerned, or between two percent and five percent of the levels of health expenditure typically found in low-income countries.
Although health workers are at the frontline of national HIV/AIDS programmes, they often do not have adequate access to HIV/AIDS services themselves. The 'Treat' component of the plan represents a full package of HIV/AIDS prevention, treatment and care services that should be made available to health workers on a priority basis and tailored specifically to their needs. These include:
- Specially designed awareness and anti-stigma and discrimination campaigns
- Testing and counselling services
- Priority access to antiretroviral treatment for health workers and their families
- Protection from HIV transmission in the health care environment, including access to post-exposure prophylaxis
The 'Train' aspect involves strategies for countries to expand the numbers of new health workers and maximize the efficiency of the existing workforce. These include:
- Recruiting and training additional health workers
- Shifting tasks from more- to less-specialised health workers (e.g., from specialists to physicians, physicians to nurses, and nurses to community health workers and lay providers including people living with HIV)
- Increasing the number of graduates by improving and expanding pre-service training in medical and nursing schools, and incorporating AIDS-specific training
- Providing in-service training to health workers already in the health system to empower and better equip them with the skills needed to more effectively care for patients living with HIV/AIDS
'Retain' relates to a set of interventions to help ensure that countries are able to keep existing workers employed in the health system. These include:
- Instituting policy changes, codes of practice and ethical guidelines to minimize migration of health workers from low-income countries to developed countries
- Diminishing the draw of private-sector and NGO HIV/AIDS programmes on workers in public health systems
- Improving the quality of the workplace environment, including establishing occupational health and safety procedures, reducing the risk of contracting HIV and other blood-borne diseases and addressing workplace issues such as stress and burnout
- Supporting staff and families with HIV by guaranteeing job security, prohibiting discrimination, providing social benefits and adjusting work demands
- Providing financial incentives, as well as non-financial incentives such as career and training opportunities, transport and HIV treatment access for family members
WHO's Priority Action Steps
To ensure the success of 'Treat, Train, Retain', WHO has identified the following priority action steps:
- Establish a special steering committee that will advocate for the 'Treat, Train, Retain' plan, guide the implementation of its activities, and monitor progress
- Provide guidance and technical assistance to national governments for the implementation of the activities outlined in the 'Treat, Train, Retain' plan
- Promote global recognition of the health workforce as a 'vulnerable group', with campaigns targeted specifically to the well-being of health workers within the context of the HIV epidemic
- Design and facilitate the implementation of a global agenda on task shifting to expedite the world's response to the human resource crisis
- Advocate for financial incentives to retain health workers and research potential options for non-financial incentives.
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