A national survey of the impact of rapid scale-up of antiretroviral therapy on health-care workers in Malawi : effects on human resources and survival

• Published in: Bulletin of the World Health Organization Vol. 85; no. 11; pp. 851 - 857
• Main Authors: MAKOMBE, Simon D, JAHN, Andreas, HARRIES, Anthony D, TWEYA, Hannock, CHUKA, Stuart, YU, Joseph Kwong-Leung, HOCHGESANG, Mindy, ABERLE -GRASSE, John, PASULANI, Olesi, SCHOUTEN, Erik J, KAMOTO, Kelita
• Format: Journal Article
• Language: English
• Published: Genève Organisation mondiale de la santé 01.11.2007; World Health Organization
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Aged; AIDS; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - therapeutic use; Biological and medical sciences; CD4 Lymphocyte Count; Clinical outcomes; Clinics; Cross-Sectional Studies; Drug therapy; Female; Health aspects; Health Care Rationing - organization & administration; Health facilities; Health Personnel - statistics & numerical data; Health services; Highly active antiretroviral therapy; HIV; HIV infection; HIV Infections - drug therapy; HIV Infections - mortality; Human immunodeficiency virus; Human resources; Human viral diseases; Humans; Infectious diseases; Malawi - epidemiology; Male; Medical personnel; Medical sciences; Middle Aged; Miscellaneous; Nurses; Patients; Private sector; Public health. Hygiene; Public health. Hygiene-occupational medicine; Public sector; Surveys; Survival Analysis; Tuberculosis; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Workers; Workforce; Workforce planning; Malawi; Africa; Human; Immunopathology; Antiretroviral agent; Human capital; Evaluation scale; Health staff; Health care staff; AIDS; Immune deficiency; Survival; Infection; Chemotherapy; Treatment; Viral disease; Antiviral; Tropical medicine; Public health
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.07.041434

To assess the human resources impact of Malawis rapidly growing antiretroviral therapy (ART) programme and balance this against the survival benefit of health-care workers who have accessed ART themselves. We conducted a national cross-sectional survey of the human resource allocation in all public-sector health facilities providing ART in mid-2006. We also undertook a survival analysis of health-care workers who had accessed ART in public and private facilities by 30 June 2006, using data from the national ART monitoring and evaluation system. By 30 June 2006, 59 581 patients had accessed ART from 95 public and 28 private facilities. The public sites provided ART services on 2.4 days per week on average, requiring 7% of the clinician workforce, 3% of the nursing workforce and 24% of the ward clerk workforce available at the facilities. We identified 1024 health-care workers in the national ART-patient cohort (2% of all ART patients). The probabilities for survival on ART at 6 months, 12 months and 18 months were 85%, 81% and 78%, respectively. An estimated 250 health-care workers lives were saved 12 months after ART initiation. Their combined work-time of more than 1000 staff-days per week was equivalent to the human resources required to provide ART at the national level. A large number of ART patients in Malawi are managed by a small proportion of the health-care workforce. Many health-care workers have accessed ART with good treatment outcomes. Currently, staffing required for ART balances against health-care workers lives saved through treatment, although this may change in the future.