The double burden of human resource and HIV crises: a case study of Malawi

Abstract

Two crises dominate the health sectors of sub-Saharan African countries: those of human resources and of HIV. Nevertheless, there is considerable variation in the extent to which these two phenomena affect sub-Saharan countries, with a few facing extreme levels of both: Lesotho, Zimbabwe, Zambia, Mozambique, the Central African Republic and Malawi. This paper reviews the continent-wide situation with respect to this double burden before considering the case of Malawi in more detail. In Malawi, there has been significant concurrent investment in both an Emergency Human Resource Programme and an antiretroviral therapy programme which was treating 60,000 people by the end of 2006. Both areas of synergy and conflict have arisen, as the two programmes have been implemented. These highlight important issues for programme planners and managers to address and emphasize that planning for the scale-up of antiretroviral therapy while simultaneously strengthening health systems and the human resource situation requires prioritization among compelling cases for support, and time (not just resources).

Figure 1

Countries with a critical shortage of health service providers (doctors, nurses and midwives). (Source: World Health Report (2006), Working Together for Health, Geneva: WHO [1]).

Figure 2

Total numbers of doctors, nurses and midwives against adult HIV prevalence across African countries for which both statistics are available. (Source: Authors' analysis based on HRH global atlas and UNAIDS data).

Figure 3

Percentage of existing doctor workforce required for full coverage in 10 years. (Source: Smith 2005 [6]).

Figure 4

Health expenditure in Malawi by provider sector, 1998/9 FY. (Source: Government of Malawi, Ministry of Health and Population: Malawi National Health Accounts: a broader perspective of the Malawian Health Sector, 2001).