Capacity shortfalls undermine roll-out

Scaling up the national HIV/AIDS treatment programme will cost the South African government US $1 billion in 2009 compared to the US $52 million currently being spent, according to a new report. The annual health review, compiled by Health Systems Trust (HST), a research organisation, warned that considerable financial resources would be required to meet the national HIV/AIDS treatment plan's targets in the next few years. The health department aims to provide ARVs to more than one million HIV-positive people by 2009, but the report found that the state would encounter budgetary constraints in meeting these targets. "We need new financing for the ARV rollout because this financing plan certainly does not fit [the HIV/AIDS statistics of] our [country and] province," said Professor Leana Uys, deputy vice-chancellor and head of the college of health sciences of the University in KwaZulu-Natal in Durban. KwaZulu-Natal is one of the provinces that have been hardest hit by the pandemic. A significant amount of money has been allocated to the country's HIV/AIDS programme but there is insufficient capacity to treat everyone in need: according to HST researchers, an additional 3,200 doctors, 2,400 nurses, 765 social workers and 765 dieticians would be required to distribute and monitor the life-prolonging treatment. "A number of [accredited ARV] sites have reached saturation level with their present human resource capacity and are struggling to expand their services to include all patients on their waiting lists," the report pointed out. "Limited human resources capacity is the biggest constraining factor on further rollout of the ARV programme and must be addressed as soon as possible," urged researchers Rob Stewart and Marian Loveday. They called for the state to explore nurse-based models of ARV delivery rather than the current strategy, which relied heavily on doctors. Accurate patient figures remain elusive, but HST estimated that only 12 percent to 13 percent of patients needing ARV therapy were receiving it. It was also becoming more difficult to find skilled people willing to work in the public health sector: poor salaries, lack of recognition and career insecurity had prompted many to turn to the private sector. According to Peter Barron, editor of the annual South African Health review, 80 percent of medical specialists and 60 percent of general practitioners were taken up by the private sector. "In the last nine years the number of nurses [in the public sector] has grown 6.9 percent, lagging behind [South Africa's] population growth of 14 percent," said co-editor Petrida Ijumba. HIV/AIDS and tuberculosis had spurred the demand for nurses during the same period. Prof Ronald Green-Thompson, superintendent-general of health in KwaZulu-Natal Province, commented that it was not necessarily an increase in the number of staff that would improve health services in South African hospitals, as quality of services also depended on efficient resource management. The national Department of Health has recognised this challenge and in August released a draft discussion document, 'Strategic Framework for the Human Resources for Health Plan', which could form the basis for long-term improvement of the situation. According to Barron, "The question is if the health department succeeds in implementing the human resources framework [effectively]."