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

McCoy D, McPake B, Mwapasa V - Hum Resour Health (2008)

Bottom Line: 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.Both areas of synergy and conflict have arisen, as the two programmes have been implemented.

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Affiliation: Centre for International Health and Development, University College London, 30 Guilford Street, London, WC1N 1EH, UK. d.mccoy@ucl.ac.uk

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).

No MeSH data available.


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).
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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).

Mentions: Mission facilities tend to operate independently of each other but within a loose association called the Christian Health Association of Malawi (CHAM). A formal agreement exists with the Ministry of Health whereby most of the CHAM workforce is paid from the government payroll. Other providers include islamic health facilities, NGOs, grocery stores, pharmacies and community-based distribution agents for contraception. The share of total health care expenditure in 1998/9 amongst different providers is shown in Figure 4. Since then, NGO health care provision has expanded, particularly NGOs providing HIV/AIDS services. There are also a number of clinical research projects, particularly related to HIV/AIDS in the health care system – these provide services to research subjects but also consume a significant number of the country's scarce skilled health workforce (see Figure 4).


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

McCoy D, McPake B, Mwapasa V - Hum Resour Health (2008)

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).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2533352&req=5

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).
Mentions: Mission facilities tend to operate independently of each other but within a loose association called the Christian Health Association of Malawi (CHAM). A formal agreement exists with the Ministry of Health whereby most of the CHAM workforce is paid from the government payroll. Other providers include islamic health facilities, NGOs, grocery stores, pharmacies and community-based distribution agents for contraception. The share of total health care expenditure in 1998/9 amongst different providers is shown in Figure 4. Since then, NGO health care provision has expanded, particularly NGOs providing HIV/AIDS services. There are also a number of clinical research projects, particularly related to HIV/AIDS in the health care system – these provide services to research subjects but also consume a significant number of the country's scarce skilled health workforce (see Figure 4).

Bottom Line: 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.Both areas of synergy and conflict have arisen, as the two programmes have been implemented.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for International Health and Development, University College London, 30 Guilford Street, London, WC1N 1EH, UK. d.mccoy@ucl.ac.uk

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).

No MeSH data available.