KHOPOTSO: That is the finding of a four-country study conducted by the French humanitarian group, Medicins Sans Frontieres or Doctors Without Borders (MSF). The study monitored public sector antiretroviral programmes in the southern African countries of Malawi, Mozambique, Lesotho and South Africa. Sharonann Lynch is the HIV/AIDS Treatment Literacy Coordinator for MSF’€™s Lesotho mission.

SHARONANN LYNCH: In the four countries, South Africa, Mozambique, Malawi, Lesotho, the number of people in need of treatment who are not getting it ‘€“ combined – is over one million people. Now if these one million people do not receive access to treatment they will die.

KHOPOTSO: The study, titled ‘€œHelp Wanted’€, contends that the continuing shortage of staff could lead to the failure of public ARV programmes in the southern African region, which has the highest concentration of HIV infections in the whole of Africa.      

SHARONANN LYNCH: If we are to have any hope of reversing the downward spiral, emergency retention measures have to be developed by governments to break the cycle of high attrition. This has to include improving the salaries, improving the working conditions’€¦ The lack of health staff is a deadly impediment to expanding and sustaining HIV/AIDS treatment. It must be confronted as an emergency for the millions of people who are still waiting for treatment.                      

KHOPOTSO: The neighbouring mountain Kingdom of Lesotho has a tiny total of 89 doctors for a population of 1.8 million. This means that the provision of AIDS treatment cannot solely depend on doctors, as is the policy for the prescription of ARVs in South Africa. As a result, AIDS treatment in Lesotho is largely nurse-driven. However, the challenge is universal. Lesotho is experiencing a critical shortage of professional nurses. Dr Pheello Lethola is a field doctor with the MSF mission there.    

Dr PHEELLO LETHOLA: Why is that so? (It’€™s) because the nurses are dying from HIV/AIDS. Secondly, there’€™s a high attrition of nurses from the public sector to private sectors within Lesotho, to South Africa and to the UK, mainly for better salaries and for better working conditions. For example, in the Scott Health Service Area where we’€™re working, just this past year, we lost about 25 nurses. Fifty-four percent of the professional nurse posts are vacant in the primary health care clinics.                              

KHOPOTSO: Thyolo District is in a country north of Lesotho. It has one government hospital, one mission hospital and 17 health centres. The district is 97% rural with a 20 % HIV prevalence rate among women attending ante-natal care clinics. Professional nurse, Veronica Chikafa, has been working with the MSF as a nurse in Malawi for five years.

VERONICA CHIKAFA: The situation is that one nurse in a ward looks after 100 very sick patients. There is also a cadre of health personnel called medical assistants that is trained for two years to perform some of the doctors’€™ tasks. To do adequate examination(s), the medical assistant is expected to see an average of 24 patients in a day. But the reality is that one medical assistant can see up to 100 patients in a day. The challenge, therefore, is that the care that is being provided becomes compromised.

KHOPOTSO: The Malawian government has put in place efforts to address the crisis of human resources for health, including the training of more health workers. But this is a time-consuming exercise which fails to address the immediate needs of staffing the health service. Donors are also helping to increase the salaries of health personnel, which has helped reduce the migration of health workers. But in addition to the improvement of working conditions and salaries, the MSF report calls for governments and health professionals’€™ councils to remove certain rules that it says prevent the health service from rendering an effective AIDS treatment programme. Sharonann Lynch, again:    

SHARONANN LYNCH: In South Africa, nurses right now are not allowed to prescribe ARVs, lay counsellors are not allowed to administer HIV tests. Staff shortages, combined with these restrictions do create deadly impediments, deadly bottle-necks which result in the shocking decrease of the number of new people we can put on ARVs each month. In Lesotho, the government, out of desperation, has realised it needs all levels of nurses, all levels of health workers to be part of the fight in terms of prescribing ARVs and giving care at the rural level. The government also approves of using lay workers to carry out some of the clinic support tasks’€¦ The absurd rules of the game need to change. This includes the scope of practice and other work rules that are set by the professional councils. It needs to be more flexible.