Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities

Globalization and Health

David Sanders¹  Wim Van Damme²  Gilles Dussault⁵  Uta Lehmann¹  Baltazar Chilundo³  Ruairi Brugha⁶  Regien Biesma⁶  Luc Van Leemput²  Ann Neo Parsons¹  Thubelihle Mathole¹  Elsie Makoa⁴  Tavares Madede³  Isabel Craveiro⁵  Johann Cailhol¹ 

[1] School of Public Health, Faculty of Community Health Sciences, University of the Western Cape, Cape Town, South Africa;Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium;Eduardo Mondlane University, Maputo, Mozambique;Faculty of Health Sciences, National University of Lesotho, Maseru, Lesotho;Unit of International Public Health and Biostatistics, Instituto de Higiene e Medicina Tropical, CMDT, WHO Collaborating Centre for Health Workforce Policy and Planning, Universidade Nova de Lisboa, Lisbon, Portugal;Department of Epidemiology and Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland

关键词: Health system strengthening;    PEPFAR;    GFATM;    HIV;    Global health initiatives;    HRH policies;    Sub-Saharan Africa;    Human resources for health;   

Others  :  805278
DOI  :  10.1186/1744-8603-9-52

 received in 2013-06-24, accepted in 2013-09-25,  发布年份 2013

【 摘 要 】

Background

Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined.

Methods

A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries’ responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context.

Results

In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs.

Conclusion

Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.

【 授权许可】

   
2013 Cailhol et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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