lessons learned in hiv funding and hrh strengthening
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Lessons learned in HIV Funding and HRH Strengthening . Vienna, 17 July 2010 Dr Frank Chimbwandira HIV and AIDS Department Ministry of Health Malawi. Malawi: Some Indicators. Malawi’s health system is heavily constrained, yet …. - PowerPoint PPT PresentationTRANSCRIPT
Lessons learned in HIV Funding and HRH Strengthening
Vienna, 17 July 2010
Dr Frank ChimbwandiraHIV and AIDS DepartmentMinistry of HealthMalawi
Malawi: Some IndicatorsPopulation 13 millionGDP (US$) 265HDI 0.493 (160)Adult HIV prevalence (15-49 year olds) 12% (U=16% , R=11%)PLHIV 984,000People in need for ART (CD4≤350 cells/mm³) 433,000Population per nurse 1,800Population per physician 49,000PLHIV per nurse 135PLHIV per physician 3,700Total Health Expenditure (average exchange rate) US$ 21
Malawi’s health system is heavily constrained, yet …
… the coverage of the programme is higher than what one would expect on the basis of existing capacity
• By the end of March 2010 over 211,000 people were alive and on (coverage 49% based on CD4 cut-off of 350 cells/mm³)
• In 2009 over 1.7 million people tested and counselled for HIV
• ART services provided in 370 health facilities, PMTCT in 650 health facilities and HTC in more than 850 health facilities in the country.
Main question How to develop a successful HIV programme without undermining
other health services? Or, even better. Could the HIV programme support the development of other health services?
Design of the programme
- Base the programme on realities in the health sector
Address HRH issues
- Make optimal use of existing staff (task shifting)- Make health workers a special target in the HIV programme- Advocate for improving HRH improvements
Based on realities – a public health approach
Reduce complexity of the interventions to the bare minimum!!!
Maximise health gain with (very) limited resources – standardisation; same approach in Government, mission and
private sector (NGOs and PFP)– simplification; focus on one regimen for all, make the ART and
PMTCT programme independent from laboratory monitoring, simple drug distribution system based on kit system, increase period between visits
– short training (5 days for ART programme)– supervision and monitoring (strong focus and standardised
M&E and supervision)– shifting and sharing of tasks (Cos, MAs and nurses can initiate
ART)
Task Shifting• Initiation of ART can be done by non-MD clinicians (COs and MAs) and nurses
• HIV testing and counselling is done by lay-people and health staff with a very short training (3 months - Health Surveillance Assistants - HSAs)
• Role of HSAs to be further developed and role of Expert patients to be defined.
Make health workers a special target group
•Health workers were special targets in the scale up plan–Care of Carer Programme
•Health workers are part of the population in need
-The ART programme needs approximately 800 fte HWs
- The ART programme started over 3,000 HWs on ART
Address HRH issuesAbsolute shortage of health staff
Situation in 2004:– 64% vacancies among nurses;
53% vacancies among clinical officers; 85%-100% vacancies among specialists
– Over half of 29 districts have less than 1.5 nurses per facility, and five districts have less than one
– 10 districts without a MoH doctor, four districts without any doctor at all
Advocate for support for HSSIn 2004 the HIV programme strongly rallied to support HRH and ensured the funding for a 6-year Emergency Human Resource Relief Programme (EHRRP) as the number of health workers was the most limiting factor to scale up the programme. The programme (US$ 270 million) was funded by GFATM and DFID. And the main objectives were:
– Train more health workers (doubled intake of most cadres)
– Top-up of salaries (52%)– Temporary additional staff (VSO, UNV)
Achievements of the EHRPRelative change in MOH and CHAM staffing for
5 main cadres in Malawi from 2003 to 2009 (2003=100)
-
50
100
150
200
250
2003 2004 2005 2006 2007 2008 2009
Clinical Officer
Nurse
Medical Assistant
Laboratory Technician
Physician
Lessons
• Government –Donor Collaboration was very critical in the development of EHRP
• Commitment • Multi-sectoral involvement was critical
Conclusion
• HIV funding has contributed to HSS through– Recruitment– Retention– Training
• Tuition• Infrastructure
Thank you very much!