Overview of presentation

1. WILL WE ACHIEVE UNIVERSAL ACCESS TO HIV/AIDS SERVICES WITH THE HEALTH WORKFORCE WE HAVE?South Africa's program to strengthen Human Resources for HIV scale upYogan Pillay Satellite session at the XVIII International AIDS Conference, Vienna: Wednesday 21 July, 6:30 - 8:30 pm, room 4

2. Overview of presentation • Burden of disease • Challenge presented by HIV and AIDS • Targets • Response in last 3 months • Conclusions

3. SCALE OF THE CHALLENGE

4. The Lancet - 12 September 2009 4

5. HIV prevalence among women presenting at public sector antenatal clinics, 1990-2008 5

6. Average antenatal prevalence is 29.3% Of 52 health districts: 4 districts recorded HIV prevalence above 40% 17 districts recorded between 30% and 40% 19 districts recorded HIV prevalence between 20% and 30% 6

7. HIV prevalence distribution among antenatal women by district, 2008 - KZN Lowest prevalence is 29.2%. 7 districts in high 30’s 3 districts above 40% Umkhanyakude 39.9% Amajuba Zululand 34.7% 36.1% . Umzinyathi 29.2% Uthukela Uthungulu 38.6% 36.1% Ilembe 35.8% Umgungundlovu 45.7% Sisonke Ethekwini 35.8% 40.3% HIV Prevalence range Ugu 40.6% 20 - 30% >30 – 40% >40% Kilometers 0 25 50 100 150 200 >40% Kilometers . 7

8. Maternal Mortality • Institutional Maternal Mortality Ratio: • HIV-negative women: 34/100,000 live births • HIV-positive women: 328/100,000 live births • Women not tested for HIV: 275/100,000 live births 8

9. Child Mortality 57% of deaths of children under the age of 5 during 2007 were as a result of HIV Babies who are HIV-positive are 15 times more likely to die within the first six months of life than uninfected babies 9

10. GENERAL HRH CHALLENGES • Too few health professionals (could do with 30 000 more) • Decentralised health system introduced many new layers of managers/admin personnel • More professional nurses than assistant nurses • Skill levels of health professionals

11. HRH CHALLENGES CONTD • Many vertical programmes • Admin burden (16 registers) • Inadequate co-ordination of community health workers • Wage costs increasing significantly • Limited linkage between need and production (autonomy of universities)

12. HRH CHALLENGES • Impact of HIV & AIDS on health workers: • increased workload • dealing with death • dealing with own HIV • Inadequate HR management

13. OUR RESPONSE

14. The National Strategic Plan for HIV and AIDS and STIs • The NSP has two primary objectives: • Reduce the rate of infections by 50% • Provide comprehensive treatment to 80% of the people who require it. 14

15. World AIDS Day 2009 • President Zuma’s inaugural HIV & AIDS address to the nation. • All public health facilities to provide HIV testing • All PHC facilities to provide ART • Four key priority groups @ CD4 <350: • Pregnant women • Children under one year • Infants (6 weeks) using combination therapy • Those co-infected with TB and HIV 15

16. Targets: 2011 • 15 million people to be screened for a comprehensive package of tests by June 2011. • Add 500,000 new patients onto ART by March 2011 • All public health facilities to test and treat TB and HIV • Schools HCT programme 16

17. Full range of services provided as part of the HCT campaign • HIV counselling and testing (HIV) • Blood pressure (Hypertension) • Blood sugar (Diabetes mellitus) • HB (Anaemia) • TB screening (symptomatic screening, 5 questions) • STI screening • Male & female condom provision 17

18. ‘Innovations’ • Nurses trained to prescribe and dispense • Recruiting retired nurses and volunteers • Public private partnerships (pharmacy groups, GPs, hospital groups) • Training of pharmacy technicians in addition to pharmacy assistants (2011)

19. ‘Innovations’ contd • Clinical associates (3 year programme) • Use of integrated in-service training programmes (PALSA and IMCI) • Getting the hospitality industry to distribute condoms • Big business promises to test 2m people

20. Key HRD challenges in HCT campaign • Not being entire sure which facilities will offer the service so can’t train the ‘right’ people • Facility managers unwilling to release nurses for off site training (overworked) and not willing to initiate patients at clinic (already overloaded) • Inadequate co-ordination of training with multiple training organisations and sources of funding

21. Key challenges in the campaign • Lack of co-ordination between province and district • Drugs not available • Authorisation for nurses to prescribe/dispense not always provided • System devalues ‘in-service training’

22. Campaign and treatment expansion status report 22

23. What needs to be done? • Task sharing/shifting • Greater in-service and on site learning • Greater support for front line workers • More effective HR planning, including links between types & numbers required and production by training institutions

24. Conclusions • High burden of disease: quadruple BOD • Scarce HR (even without HIV) • How to deploy HR, train and manage this resource effectively is key to a successful health system • Scale and quality assurance/improvement must go together • But will we achieve universal access with the current HRH…. ‘We have no choice’

25. Thank you for your attention!!!