Current donor policies are partly to blame for a dire lack of healthcare workers in southern Africa, international medical relief agency Medecins Sans Frontieres (MSF) has said.
A recent four-country MSF report, Help Wanted, says staff shortages, which are often the result of inadequate salaries, also prevented the further expansion of HIV/AIDS care and treatment programmes in the region.
"Western and European aid programmes do not help pay nurses' salaries because the effort was considered 'unsustainable'," according to the report.
By pushing countries to limit wages, the International Monetary Fund (IMF) has also been accused in the report of restricting African governments from raising salaries as a way of easing the 'brain drain' of home-grown medical expertise.
Exploring the situation in Lesotho, Malawi, Mozambique and South Africa, the report estimated that more than 1 million people were in need of antiretroviral (ARV) drugs in each of the surveyed countries but were unable to access them.
Doctor Eric Goemaere, the head of mission for MSF in South Africa, said donors' willingness to build clinics without providing or helping to retain the staff to manage them was similar to "arranging chairs on the Titanic as it sank".
But Rafiq Hajat, director of the Institute for Policy Interaction, in Blantyre, Malawi, noted that regional governments were also not entirely blameless.
Governments had a role to play in the extent to which the necessary interventions could be implemented, but were often caught up in their own bureaucratic red tape, according to Hajat.
MSF noted that donors and other international actors recognised the human resource problem but, with a few exceptions, still do little to address it.
Glimmer Of Hope?
In Malawi, however, there was a glimmer of hope with the government having agreed to increase health worker salaries, with assistance from international donors.
Together with the donors, the Malawi government in 2004 launched a six-year Emergency Human Resources Programme, which allowed for the pooling of funds from members that include, among others, the British aid programme (DFID) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, with the aim of recruiting, retaining and training staff.
Cynthia Rowe, the governance advisor at DFID in Malawi, confirmed that the UK government's development agency had allocated about US$100 million toward the kitty over six years.
"The Emergency Human Resources Programme has increased salaries for 11 categories of health workers, is increasing the capacity of the training institutions in Malawi, and government has carried out a study to trace and recruit health workers who have left the public health systems." Rowe said.
The programme also includes funding for recruitment of doctors and tutors from UN Volunteers and Voluntary Services Overseas, increased and improved staff housing particularly in rural areas, and improved career development as incentives for staff.
Although progress will take time in Malawi, there are indications that some elements of the plan are beginning to stimulate change. For example, the intervention had slowed migration of health staff to the UK, from 88 nurses in 2005 to 23 in 2006.
Meanwhile, for those nurses still waiting for reprieve, the work load continues to take its toll.
Falling Through The Cracks
"There are so many patients here to see ... yesterday I was alone on duty without even any medical assistant to help me. Sometimes I have to do both day and night shifts in the same day! We need at least five more nurses here," the MSF report quoted Loveness Makeyi, a nurse/midwife, in Malawi's Khonjeni Clinic, as saying.
MSF reported that in addition to health systems competing for workers in a globalised economy, nurses and doctors were also succumbing to AIDS-related illnesses.
"In Lesotho, Mozambique, and Malawi, death is the leading cause of health worker attrition, with a significant proportion being HIV-related. Availability of confidential HIV testing, care, and treatment services for health workers is of utmost importance," the report reads.
Describing the partnership as "a much-needed intervention", Alfred Chirwa, the health advisor at the Malawi office of the World Bank, also stressed the need for urgency on the part of the role-players.
"Although the Malawi SWAP initiative is promising, it has not been without its share of problems," he told IRIN/PlusNews. Disagreement between the government and the Global Fund on how to channel funds has stalled fund disbursements, for example.
Despite a global effort to expand access to HIV/AIDS care and treatment over 8,000 people with HIV/AIDS are still dying every day.