Health systems - a strong foundation to support HIV/AIDS services

Submitted by Parsa Sanjana

There has been much discussion recently regarding the effect of HIV/AIDS programs on strengthening health systems as a whole. To take a step back, I would like to discuss how addressing health systems issues are critical to strengthening HIV/AIDS programs.

During my first visits to Zambia four years ago, travelling to government health centers in rural, hard-to-reach areas, it was apparent that HIV/AIDS services were in dire need. But the problem wasn’t just that HIV/AIDS services were lacking at these facilities – they lacked the manpower to provide even the most basic clinical care. At one clinic on an island in northeastern Zambia, just miles from the Democratic Republic of Congo, the one health worker assigned to the facility rarely showed up for work. At a major hospital in central Zambia, many of the surgical nurses had died that year. I visited health centers with non-medical staff providing services to the best of their abilities, including treatment for basic ailments and delivering babies

The situation is quite severe across Zambia, with half of all health worker positions in the country vacant. Shortages exist across every cadre, and are most acute in rural areas. In addition to challenging the nation’s capacity to address basic health problems, the human resources crisis has also affected Zambia’s ability to address its HIV/AIDS epidemic - 16% of adults are infected with the virus. Addressing health systems issues is critical to alleviate the dearth of health workers and mitigate the impact of HIV/AIDS.

The Zambian government, with the support of donors, has recently carried out initiatives focused on providing incentives to medical officers and nurses willing to serve in rural areas. In addition to providing monetary incentives, these initiatives are improving staff housing for health care workers and improving working conditions at health facilities by proving water, electricity and communication services as feasible. In addition, there are initiatives looking at the problems from a broader perspective, including improving the Ministry of Health’s processes and systems to employ health care workers and developing creative solutions to motivate Zambian health workers practicing in other countries to return home. Increasing the number of health care workers is only one way to address the human resource shortages.

Health facilities are increasingly reliant on using trained community volunteers to provide HIV counseling and testing (using rapid test kits in accordance to national guidelines) to clients. Community volunteers, many of whom are HIV + and on antiretroviral therapy (ART), are also trained to provide adherence counseling and follow-up to patients on ART. Experience from several programs have shown that task-shifting does result in high quality services for clients and reduced burden on overstretched health care workers time. However, these “lay” cadres need to be formally recognized and integrated into the national health system to meaningfully address human resource issues.

These initiatives are just a few ways that health systems can be strengthened to provide a strong foundation to support quality HIV/AIDS services.

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