Rural health "motivators" could ease professional shortage

A critical shortage of health professionals in Swaziland is undermining the public health system's capacity to expand its national antiretroviral (ARV) programme, health officials have warned. A recent situation analysis carried out by the World Health Organisation (WHO) revealed the extent of the problem in a country with one of the highest HIV prevalence rates in the world. The WHO study noted there was an overall lack of staff in key areas of the health sector resulting in services either being stopped or quality of care being compromised. Huge imbalances in the distribution of available staff had seen rural health facilities losing out to private urban hospitals and clinics, while the migration of health personnel to developed countries had placed additional pressure on the health sector. According to WHO's Swaziland Representative, Dr David Okello, the "single most important" obstacle to reaching the target of 6,000 people on treatment by the end of 2004 was "the human factor". "The health system seems to be in place, the facilities are well spread throughout Swaziland and there is a drug supply system. But there are too few people to run the programme," said Okello. The WHO report noted that there was one doctor per 5,953 people and one professional nurse per 356. There were even fewer pharmacists and laboratory technicians. Okello pointed out that Swaziland had no medical schools or training facilities for laboratory technicians. "This means the public health system depends on nurses and midwives. Sadly, they are becoming a commodity which is selling like hot cakes, because they are being pulled across the border to South Africa and beyond. So the people we depend on are now being taken away," he added. The report called for the recruitment of health professionals from other countries - medical doctors were usually recruited from overseas, but the government employed only Swazi nurses and this "outdated policy" should be revoked. "We are not asking for manna from heaven, just simple readjustments," Okello said. But there were glimmers of hope: the report identified rural health motivators as a potential source of support for communities as the country rolled out antiretrovirals. Swaziland has about 4,000 rural health motivators, selected by the chief in the area to assist local communities by promoting health care and managing health problems. Motivators, usually older women, have to undergo a 10-week training programme where they are taught to recognise common conditions and administer home-based care. "We need to demystify treatment - we can't wait for there to be enough doctors," Okello said. "This is where rural health motivators come in, if we re-orient them and use the skills they have."