Health worker shortage threatens goal of seeing AIDS-free generation

by Gayle Northrop
Sunday, 1 December 2013 00:30 GMT

In early November, on the banks of Lake Malawi in Mangochi, Malawi, more than 60 health professionals gathered for a seven-day PMD training to learn new techniques on a range of critical health administration issues including, organisational planning, finance and supply chain management, and system assessment./HANDOUT

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An AIDS-free generation will only be possible with skilled health staff and competent managers who can coordinate the resources needed to orchestrate a continuum of care

A new report from the World Health Organization’s Global Health Workforce Alliance draws the clearest connection to date between health professionals and child survival. WHO estimates that by 2035, we will have a shortfall of roughly 12.9 million skilled health workers including midwives, nurses and physicians who both care for women, children, and families and manage the health system that support the community.

For the community focused on eliminating mother-to-child transmission of HIV, this is devastating. This shortage has the potential to undo the progress we have made toward reducing pediatric HIV by 38 percent since 2009 – and waylay our goal of seeing an AIDS-free generation. 

Why? Because skilled health workers are the constant force who will treat adults living with HIV, educate parents on how to prevent passing it onto their partners and children, and manage the clinics at the center of community health.

When HIV positive mothers have access to antenatal care (ANC) and anti-retroviral medications during their pregnancy, and if their newborns receive medication after delivery and during breastfeeding, there is a greater than 95 percent chance that the baby will be HIV-negative. 

That means, then, that mother to child transmission of HIV can be eliminated, or at least ‘virtually’ eliminated (when transmission from mother to child occurs in less than 5% of the population). 

We can see an AIDS-free generation, in our lifetime – even in Africa, where 91% of the world’s HIV-positive children live. But this is only possible with skilled health staff and competent managers who can plan and coordinate the resources needed to orchestrate a continuum of care from pregnancy through delivery and beyond. 

With support from Johnson & Johnson, MAC AIDS, USAID, and others, the Partnership for Management Development (PMD) is helping government health managers in Africa learn the skills they need to transform our health work force and the delivery of care. 

These are the professionals who are and will continue to be in the driver’s seat of eliminating mother to child transmission of HIV.  Faculty from University of Cape Town Graduate School of Business provide these managers with critical non-clinical skills – skills in planning, operations, finance, human resources, and supply chain management – so they can make important decisions – management decisions – on the front lines of health system delivery.  

The fact is, these ‘managers’ are often not managers at all.  They are nurses, midwives, pharmacists and doctors who typically have not received the management training they need to manage the people, order the inventory, or allocate and account for the funds they are responsible for.

Too often, they don’t view themselves as powerful agents of change, problem solving and innovation. Yet, as we look beyond 2015, these professionals are in the best position to build on and sustain the gains we’re making in maternal health and child survival. 

This is a major focus of this year’s Global Forum on Human Resources for Health. Once health professionals are armed with critical skills in leadership and management, they approach their work in a new way and, based on our research, have the potential to make an immediate impact. 

The facilities our graduates manage are seeing fewer drug stock-outs and have more reliable health data. They are also providing more women – and men – with the pre- and antenatal care needed to keep a generation healthy and AIDS free. 

Preventing mother to child transmission of HIV requires more than clinical expertise, access to affordable medicines, and funding. If we are to see an AIDS-free generation, we have to tackle the issue from all angles – beginning with training the professionals who currently care for mothers and children with skills that extend beyond the exam room into the effective operations of a health facility. 

Management and leadership skills, integrated service delivery, innovation and a problem-solving mindset must converge on the front lines of service delivery. 

This is where health care managers have the responsibility, and therefore must have the competency and motivation, to improve their own health system and fundamentally change how health care is delivered to mothers and children in Africa, and around the world. 

Gayle Northrop (@gaylenorthrop) is associate director of Johnson & Johnson’s Partnership for Management Development, Adjunct Faculty at the University of Cape Town Graduate School of Business in South Africa, and consultant to NGOs worldwide on strategy, governance, organization development and impact