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Effect of Global HIV/AIDS Initiatives on Human Resources at sub-national level in Malawi Baseline Study Findings

Effect of Global HIV/AIDS Initiatives on Human Resources at sub-national level in Malawi Baseline Study Findings. Victor Mwapasa 1 John Kadzandira 2 College of Medicine, University of Malawi. Centre for Social Research, University of Malawi

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Effect of Global HIV/AIDS Initiatives on Human Resources at sub-national level in Malawi Baseline Study Findings

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  1. Effect of Global HIV/AIDS Initiatives on Human Resources at sub-national level in MalawiBaseline Study Findings Victor Mwapasa1 John Kadzandira2 College of Medicine, University of Malawi. Centre for Social Research, University of Malawi Funding: Alliance for Health Policy and System Research Technical Assistance: Sara Bennett

  2. HIV/AIDS in Malawi • Burden of HIV • HIV prevalence (15—49 yrs): 11.8% • Estimated # of PLwHA: 1m • # needing ARVs: 245,000. (June 07: 114, 375) • Global Health Initiatives • Global Fund ($196m for 2003-08; $85m for 2006-11) • World Bank-MAP ($35m for 2003-08) • PEPFAR (? Budget, relatively smaller) • Others • Multilateral Agencies (mainly technical Support) • Bilateral Donors (CIDA, DFID, NORAD, CDC & USAID) • Government of Malawi ($2m/year) • Private Sector

  3. Implementation of HIV/AIDS Interventions • Implementation of GHI-funded HIV/AIDS interventions • Started mid-2004 • Central Hospitals District Hospitals sub-district facilities • Roll-out of interventions by Dec 2005 • ART & PMTCT: district hospitals • HIV Testing & Counseling (HTC): sub-district health facilities • Community Home-based Care: community level • Health system challenges: • human resources • frequent stock outs of drugs and medical supplies • poor access to health services, especially rural residents

  4. Objectives of Malawi’s study • Preliminary study at central level in 2005 • No planning for HR to deliver HIV/AIDS interventions • Emergency HR Relief Programme • Training output, staff retention, rational staff deployment • Study focus: • Effects of GHI-funded interventions at district & sub-district level on staff workload and time allocation for focal and non-focal diseases • Baseline study: Dec’06-Jan 07 • Follow-up study: June 08

  5. Methodology • 9 districts in 3 regions • District hospitals • 4-6 sub-district facilities • Managers • Officer/nurse in-charge • Lab and Pharmacy • Human Resource • ART, PMTCT, HTC • Coordinators • Service Providers • Health Facility records • Inpatient, outpatient stats Nkhatabay Mzimba Salima Mchinji Lilongwe Mangochi Mwanza Blantyre Chikwawa Methodology

  6. Results

  7. Health worker trends at District hospitals • Modest increase in # of clinicians in District Hospitals but perceived decrease

  8. Health worker trends at District hospitals • Modest increase in # of nurses, pharmacy and laboratory staff at district hospital but perceived decrease

  9. Rural Health Center staff • HR worse in rural > urban health centres • 21.0 (4/19) had no medical assistant • 26.3% (5/19) had no enrolled nurse/midwife. • Big disparity of nurses between rural and urban HC • Nurse distribution: 23.7% in rural HC, range (17.6-46.0%)

  10. Workload and its effects • Perceived increase in workload • Concomitant implementation of HIV and non-HIV services • No shift of staff between programmes • Locums—but not in rural health centres • No adverse effect on non focal diseases • Immunizations • Antenatal clinic attendance

  11. Trends in immunizations Rural Health Centre Rural in urban District Hosp Rural Hosp Urban HC

  12. Trends in ANC attendances District Hosp Rural in urban Rural Rural Hosp Urban HC

  13. Levels of Motivation & Satisfaction • Depended on HIV programme & level of care • Majority felt satisfied with their job • ART service providers > PMTCT providers • District level > health centre level • Reasons: • training opportunities: per diems and time off-work • perceived impact of intervention • Reasons for poor motivation and satisfaction • lack of resources • Workload • Poor incentives and salary

  14. Discussion • HR challenges at sub-district level may be worsening • review implementation of deployment and hardship incentive policy • No evidence of GHI interventions affecting output for non-HIV interventions • Difficulties to isolate the sole impact of GHIs • ?Quality of services

  15. Discussions/Conclusion • ?In areas with HR constraints, avoid specific staff supplementation to deliver HIV services • Needs a comparative country (ref: Zambia) • Resolving of HR problems is a slow process • Need long time donor commitment • In the interim countries must implement appropriate policies the available HR

  16. Future Research Direction • Revisit same facilities after 18 months • Examine trend in services outputs • Levels of staff motivation • Implementation of staff deployment policy

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