Rapid expansion of the health workforce in response to the HIV epidemic.

The World Health Organization (WHO) estimates that there is now a global deficit of more than 4 million trained health workers. The shortages in health workers are critical in 57 countries, mostly in sub-Saharan Africa and parts of Asia. The situation is further exacerbated by the direct effect of the human immunodeficiency virus (HIV) on health workers in resource-constrained countries in which the disease is epidemic. Poor working conditions and low pay conspire with the risks of occupational transmission and the stress of working in communities devastated by the HIV epidemic to drive up rates of attrition. Many health workers resign; others migrate to better jobs abroad or to the private sector or leave health work altogether. In countries with the highest rates of HIV, leading causes of attrition are the morbidity and mortality caused by HIV itself. In Botswana, 17% of the health workforce died from diseases related to AIDS from 1999 to 2005.1 In a vicious circle, the epidemic fuels the crisis in the health workforce at the same time that the shortage of health workers presents a major barrier to preventing and treating the disease. In Malawi, the number of people living with HIV/AIDS was 7435 per doctor, according to 2004 figures. By comparison, there were nearly two doctors per person living with HIV/AIDS in the United States and in the United Kingdom (Table 1). In June 2006, at the High-Level Meeting on HIV/AIDS of the United Nations General Assembly, member states agreed to work toward the goal of “universal access to comprehensive prevention programmes, treatment, care and support” by 2010. This ambitious goal has galvanized governments and international agencies into action and is already bearing fruit in terms of increased resources and political commitment. But the goal cannot be reached without a strengthening of health care systems and a significant expansion of the health workforce. The urgency of the situation, especially in many African countries, has prompted the WHO to coordinate a global effort to strengthen and expand the health workforce by addressing both the cause and the effects of HIV in health workers. Representatives from health ministries, professional associations, academic institutions, civil organizations, and United Nations organizations have formed a partnership to implement a plan of action called “Treat, Train, Retain.” The plan aims to prevent HIV among health workers and to treat those who are infected, to expand the workforce by training new people and by making more efficient use of the current pool of human resources for health, and to retain skilled staff.