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Human Resources for HIV Scale Up in Malawi Vienna, 2010

Human Resources for HIV Scale Up in Malawi Vienna, 2010 . Frank M Chimbwandira , S Makombe, E Mhango, J Njala, L Tenthani, P Moses, E Schouten, Z Chirwa, A Jahn . Malawi Indicators. 13.06 million people 12 % HIV prevalence among 15-49 year olds About 1 million PLWH

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Human Resources for HIV Scale Up in Malawi Vienna, 2010

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  1. Human Resources for HIV Scale Up in Malawi Vienna, 2010 Frank M Chimbwandira,S Makombe, E Mhango, J Njala, L Tenthani, P Moses, E Schouten, Z Chirwa, A Jahn

  2. Malawi Indicators • 13.06 million people • 12 % HIV prevalence • among 15-49 year olds • About 1 million PLWH • 384 000 in need of ART • 211 246 PLHIV alive and on ART by March, 2010 • Approx. 700 000 orphans due to AIDS epidemic • 1 Physician : 49 000 people • 1 Nurse :1 800 people

  3. Human Resources for Health I Malawi situation in 2004: 64% vacancies among nurses; Over half of 29 districts have less than 1.5 nurses per facility, and five districts have less than one 53% vacancies among clinical officers; 85%-100% vacancies among specialists 10 districts without a MoH doctor, four districts without any doctor at all

  4. Human Resources for Health II • In 2004 Dr Peter Piot (UNAIDS) and Dr Suma Chakrabarti (DFID) were concerned “ ….. that without a substantial increase in health workers, it would not be possible [for Malawi] to roll out antiretroviral treatment without further undermining the already weak health system.” Palmer D, ……… Reproductive Health Matters 2006; 14(27):27-39…………

  5. Human Resources for Health III • Inadequate workforce in the health delivery system was aggravated by • Poor recruitment systems • Limited or non-responsive trainings • Poor staff retention mechanisms • Inadequate finances

  6. Emergency HRP I: Plan • Drawn up for 2004 – 2010 period • Focused on retention, deployment, recruitment, training and tutor incentives • Targeted 11 cadres • Physicians, nurses, COs, MAs, pharmacists, lab technicians, … and expansion of community health worker cadres • Budget: ~US$200 m  US$270 m • GoM, DFID, GFATM, Health SWAp ……

  7. Emergency HRP II: Approaches • Short-term interventions • Recruit unemployed or retired staff • Expatriate staff for TA and mentoring • Salary top-ups • Recruitment of community health workers • Long-term interventions • In-country pre-service training • Comprehensive Monitoring and Evaluation Systems

  8. Emergency HRP III: Outcomes I • More posts were filled between 2003 and 2007 • 30% increase in nurses, 40% in medical doctors, and 50% in clinical officers • Reduced emigration of nurses • Over 5600 community health workers were recruited • Training institutions created more room for enrollment: infrastructure development

  9. Emergency HRP IV: Outcomes II

  10. Some Cadres and Tasks

  11. ART Scale Up: Malawi 2009 Sites : 377 Alive: 198,846 Coverage: 53% 2006 Sites: 141 Alive: 59,980 Coverage: 17% 2003 Sites: 9 Alive: ?? Coverage: ?? 2008 Sites: 221 Alive: 147,497 Coverage: 41% 2007 Sites: 163 Alive: 100,649 Coverage: 28 % 2004 Sites: 24 Alive: 10,761 Coverage: 3% Doctors and Clinical Officers (COs) Doctors , Clinical Officers, Medical Assistants (MAs) Doctors, COs, MAs and Nurses Policy Changes: Who should initiate ART? >………………..

  12. ART Sites In Malawi

  13. HIV Testing and Counseling Year

  14. HIV Testing and Counseling 2009

  15. HTC Scale Up • Approaches • Door-to-Door HIV testing and Counseling • National HTC Campaigns • HTC weeks, targeted sites or functions • Mobile and Outreach HTC • Task shifting: • Health Surveillance Assistants do HTC • Task sharing: • Provider Initiated Testing and Counseling

  16. Challenges • Need for more workforce • Increasing number of clients on ART • Implementation of new WHO ART/PMTCT guide • Task shifting has a limit: HSAs may not initiate ART nor follow up clients • Central posts need strengthening • Eg Central Medical Stores & technical posts • Donor-dependence on staff retention: • TAs, Salary top ups ….

  17. Plans • New Programme of Work/SWAp • Under discussion with donors, HR still • Decentralise HIV services • Opening of more clinics • Engage expert patients through support groups • Strengthen Integration of HIV services • Use of new and better regimens (in ART) • Triomune  Atripla from 2011

  18. Conclusions • HR will determine further scale up of HIV services including implementation of the new adopted WHO ART/PMTCT Guidelines. • Training of more personnel (Physicians, COs, nurses and MAs) still remains an option for Malawi • Sustainable retention mechanisms are essential too.

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