Health sector crisis hampers AIDS treatment

South Africa's government has set a target of treating 80 percent of the estimated 500,000 people in need of antiretroviral (ARV) drugs by 2011, despite a severe human resource shortage.

A number of sessions at the third national AIDS conference in Durban on Thursday grappled with the thorny question of how South Africa is going to  rapidly scale up its treatment programme when a third of posts in the state health system remain stubbornly vacant.

"Things are terribly wrong in the public health sector," Prof Dingie van Rensburg told delegates at a session on the human resource challenges threatening South Africa's AIDS efforts. "Merely increasing the numbers of health workers will not be enough to solve the human resources crisis."

Unlike many other countries in the region, South Africa has a sufficient number of health workers. But the problem is their uneven distribution between the public and private sectors and between provinces, according to van Rensburg. Sixty-two percent of doctors and 58 percent of nurses work in the private sector, while 80 percent of the population relies on the public sector for their healthcare needs.

In addition, South Africa's current health dispensation was handicapped from dealing with the country's enormous HIV/AIDS burden, he said.

The main weakness, according to Van Rensburg, has been the narrow definition of HIV as merely a health problem. The epidemic's profound impact on families and communities call for the mobilisation of resources outside the health sector to focus on the social consequences of the disease.

Van Rensburg recommended tapping into the "rich pool of human resources embedded within communities" and a "layman-ising" of care. "We need to learn much more from other African countries about how they manage with lower levels of human resources," he told delegates.

Some audience members expressed concern that shifting tasks to lower cadres of health workers such as community health workers, could compromise patient care. But a number of speakers reported on successful projects that appeared to prove these fears wrong.

In Lesotho, where two million people are served by a mere 89 doctors, a pilot programme run by Medecins Sans Frontieres (MSF) has trained nurses to initiate and manage ARV treatment at 14 clinics in a deeply rural area of the country. As a result, lay counsellors have taken over some of the more basic nursing duties. Pheelo Lethola, who told conference delegates about the project, is one of two doctors who make weekly visits to the clinics to provide additional training and support.

Another success story from the poor, rural district of Umkhanyakude in KwaZulu-Natal Province offered some hope. Despite a hospital vacancy rate of 40 percent and high rates of HIV infection, the district has managed to put 10,000 people on treatment over three years and is on track to treat 80 percent of those in need, ahead of the national deadline.

The authorities received some help from the Institute for Healthcare Improvement (IHI), a non-profit US-based organisation, but Brandon Bennett of IHI attributed the district's success to a winning combination of will, ideas and execution. Progressive local leadership had recognised HIV as the district's number one priority, while listening to the ideas of care-givers at a local level and translating them into action was the crucial component.

"If we're unhappy with the roll-out, we need to realise that the system is giving us those results and we need to advocate for change," Bennett said.

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