Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care

1. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Emmanuel M. Makasa MD, MPH Zambia Medical Association Lusaka, Zambia emakasa@yahoo.co.uk Given to the Infectious Diseases Division of Brown University School of Medicine at Miriam Hospital, Providence RI, USA 21st May 2009

2. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care OBJECTIVES: • Describe healthcare system & infrastructure in Zambia. • Discuss impact of HIV & effect on health sector. • Examine interplay of human resource shortages & HIV care in Zambia. • Relevance of human resources issue to ID in the USA A man ravaged by AIDS is bathed at a hospice in Zambia (www.Time.com)

3. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Zambia’s location in the world: Country Profile: • Landmass ≈752,612 Sq Km • Population – 12million • Declining life expectancy @ birth of 37.5 years. • High dependency ratio- 47% pop aged <15yrs. • Fairly urbanized – 34.7% in urban areas. • Administrative 9 provinces. • Weak social economic position (among least developed) • Democratic gov. (two 5 yr terms) Source:www.witiger.com

4. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Zambia’s Healthcare Infrastructure: • Inadequate & poor state of essential infrastructure, equipment & transport. • Continued shortages & erratic supply of essential drugs & medical supplies. • High disease burden with critical shortages of qualified health workers at all levels of health service delivery. Zambia’s Healthcare System: • Centralized (Ministry of Health) • Three levels of healthcare. • Free public healthcare for all. • Small private sector. • Inadequate funding (<15% of national budget)

5. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care

6. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Zambia’s HIV/AIDS statistics & Response: • 1, 100, 000 people living with HIV (Total Pop. 12 million) • 15.2% Adult prevalence rate (15 – 49 yrs) • 980,000 Adults living with HIV (15-49yrs) • 560, 000 Women living with HIV (>15yrs) • 95,000 children living with HIV (0 – 14yrs) • 56, 000 Deaths due to AIDS • 600,000 Orphans due to Aids (0 – 17yrs) Impact of HIV/AIDS on Zambia General: • Retarded national development • Disrupted extended family system • Lowered life expectancy to 37.5 yrs On Health Sector: • Increase disease burden • Shortages of health facilities, supplies & staff • Morbidity and mortality of health workers from AIDS NOTE: Impact worse in rural areas Source: Epidemiological Fact Sheet on HIV & AIDS, 2008

7. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Progress towards universal access: Source: Ministry of Health, Zambia

8. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care

9. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care

10. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Source: Ministry of Health, Zambia

11. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care

12. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care

13. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Impact of HIV/AIDS and Human Resource Shortages on Zambia’s healthcare delivery. HIV/AIDS + Malaria & TB Increased Disease Burden Inadequate & poor state of Health infrastructure and medical supplies Healthcare Delivery in Crisis • HRH • Weak Retention • Death from AIDS • Inadequate training Human Resources for Health Shortages

14. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care The way forward: • Make human resources for health a priority in the fight against the HIV/AIDS. • Rural areas of Zambia should NOT be ignored as they are affected the most. • Although we need help as a country from international partners to build capacity, our future lies in our own hands. • Need for more Zambian political will and commitment to overcome the challenges we face.

15. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care What does this mean for you: • Practice & do research abroad? - Awareness of situation helpful. -Human resource issues should be part of research. • How does the Zambian situation affect you & your careers? - While there are opportunities for short term work, long term work is what is needed the most. - The role of teaching and training locals should also be a priority. • Without tackling this issue, your work in trying to fight HIV, especially in Africa, is greatly held back .

16. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Acknowledgements: • Division of Infectious Diseases • Dr. Flanigan, ID Division Chair • Susan M. Tootell & Dalila Zachary • All of you for attending

17. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care References: • World Health Organization. The World Health Report 2006 – Working together for health. • UNAIDS. Zambia – Country Response. Available at: http://www.unaids.org/en/CountryResponses/Countries/zambia.asp. Accessed May 19 2009. • Makasa E. The Human Resources crisis in the Zambian Health Sector – a discussion paper. Med J Zambia 2008;35(3) 81-87. • Ministry of Health of Zambia. Joint Annual Review for 2007 Main Report. Available at: http://www.moh.gov.zm/?q=node/publications. Accessed May 19 2009. • Ministry of Health of Zambia. National Strategic Plan 2006-2010. Available at: http://www.moh.gov.zm/?q=node/publications. Accessed May 19 2009. • Central Statistics Office Zambia. Main Zambia Census Report 2000. Available at: http://www.zamstats.gov.zm/census.php. Accessed May 19 2009.