Emebet Meshsha, 26, and Azalech Abdisa, 25, are the kind of health workers the World Health Organisation is banking on to beat the AIDS epidemic in Africa. They have only one year of health training each, yet have been a godsend to the about 5,000 people in the Ethiopian village of Ude, 55km southeast of the capital, Addis Ababa.
The two women dispense basic medicines for malaria and diarrhoea at the local clinic, and distribute food to pregnant women and young mothers. "We have benefited a lot from the child-feeding and other health activities," said Annallesm Shamay, 46, one of their patients.
Meshsha and Abdisa could soon find themselves also distributing antiretroviral (ARV) drugs for HIV/AIDS, as part of a WHO initiative to hire four million health workers in the countries hardest hit by HIV/AIDS.
"The HIV/AIDS epidemic has opened up the eyes of some politicians to bottlenecks in human resources," Anders Nordstrom, an assistant director-general of the WHO, told a conference on the initiative in Addis Ababa, which ended on Thursday. "In some ways this is very sad that we had to have this kind of epidemic to do so."
The campaign is estimated to cost at least US$7 billion over the next five years, and also calls for hiring an additional 2.4 million doctors, nurses and midwives in the developing world to help countries in need of assistance reach the UN goal of universal access to HIV/AIDS treatment services by 2010.
Is task shifting the way forward?
The plan is driven by an idea known as "task shifting", in which some tasks performed by doctors are shifted to nurses, some duties traditionally performed by nurses are shifted to community health workers, and some responsibilities of community health workers are shifted to patients or their families.
If carried through, the plan would be a major boost to health delivery systems in sub-Saharan Africa, where health care workers are in short supply. Malawi, for example, has more than 7,400 HIV-positive patients per doctor, according to the WHO; by comparison, there are two doctors for each HIV-positive patient in the US and UK.
"There is a major crisis [in health care], but if we explore all the means, there is reason to be hopeful," said Tedros Adhanom, Ethiopia's health minister, in an address to African ministers and Western donor officials at the conference.
Ethiopia serves as something of a model for the new initiative. Confronted with the epidemic, the government realised it had neither the time nor the money to train enough doctors and nurses for a country of 80 million.
Instead, it trained 24,000 women like Meshsha and Abdisa as community health workers, with the goal of assigning two to each of the country's rural health clinics. With salaries of 500 birr ($55) per month, the health workers are paid half as much as nurses and a quarter as much as doctors.
According to WHO, medical studies show that mid- and low-level health workers who specialise in particular treatment areas - such as HIV/AIDS - can be as effective as doctors in some tasks, cost less to employ and are less likely to immigrate.
"There was some reluctance on the part of professionals, believing something a doctor does cannot be transferred to a nurse, or something a nurse does cannot be shifted to a non-professional," noted Adhanom. "But we have evidence otherwise ... the way forward is mid- and low-level health care workers."
Hiring the unemployed
But the move has been met with scepticism by some professional organisations. "We're sitting with unemployed nurses in both developed and developing countries," remarked Judith Oulton, chief executive officer of the Geneva-based International Council of Nurses, which represents more than 12 million nurses worldwide.
 ...When we produce 100 doctors a year and 50 leave, it's very painful... |
Two further aspects of the WHO initiative are to ensure adequate treatment for HIV-positive health workers - AIDS is the biggest killer of health workers in Lesotho, Malawi, and Botswana - and to train more doctors and nurses, with financial incentives for them to stay in their home countries rather than emigrate to the UK, Europe and North America. This week the WHO released guidelines on the new incentives.
Some of these aspects are already being implemented: Malawi has begun offering health professionals free housing; Ethiopia has opened 13 universities in the past three years and has increased its number of new medical students five-fold to 1,000.
"When we produce 100 doctors a year and 50 leave, it's very painful," said Ethiopian health minister Adhanom. "If we produce 1,000 a year and 500 leave, it can be okay."
One of those newly trained doctors would be welcome in Ude. The two young health workers have made a difference, but are still unable to handle complicated births or treat more difficult ailments. Shamay, the patient at the clinic, commented, "They need more training; we would prefer a doctor."
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This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
