Severe staff shortages hamper AIDS treatment

The report, Help Wanted, focusing on Malawi , Lesotho , South Africa and Mozambique , indicates that more than one million people need AIDS treatment but are not getting it.

"If these people do not receive access to treatment, they will die," Sharonann Lynch, of MSF in Lesotho , told a media briefing in Johannesburg .

AIDS-drug prices have dropped and funding has increased, but there is little support for increasing human resources for health.

Treatment deficits are 40 300 in Lesotho , 109 100 in Malawi , 192 900 in Mozambique and 718 000 in South Africa .

"More pills, more infrastructure will not improve the situation ... the bottleneck is health staff," said Dr Eric Goemaere, head of MSF's programme in Khayelitsha in the Western Cape .

Health workers are dying of HIV/AIDS, overwhelmed by the HIV-related workload, and leaving the sector for better-paying jobs.

Proposed interventions include allowing nurses to prescribe antiretroviral drugs and empowering and recognising community workers as key collaborators. Emergency measures are also needed to retain staff, and salaries and working conditions need to be improved.

Goemaere pointed to "hypocrisy" in South Africa , where a "radical policy change" is needed to meet targets such as those set by the National Strategic Plan for HIV/AIDS. The plan has been "applauded and rightly so", but policy change is needed to meet targets. "To put into practice, it needs major policy changes ... People know this change needs to happen, but I don't see that happening."

Hypocrisy also exists on the side of donors who fund HIV/AIDS programmes, particularly in surrounding countries, but do not fund salaries, he said.

An exception is Malawi , where donor money has gone towards improving salaries by 30%. Field nurse Veronica Chikafa said this has slowed the migration of nurses. In that country, the number of doctors and nurses has decreased, but the number of patients has increased. A medical assistant could see as many as 100 people in a day, she said.

Lesotho has 89 doctors for 1,8-million people -- one doctor per 20 200 people -- but nurses are allowed to prescribe ARVs. Field doctor Dr Pheelo Lethola said the major challenge is a shortage of professional nurses, which leads to workload increases, demotivated nurses, an increased waiting period for nurses, and shorter consultation times.

Mozambican medical technician David Nhantumbo said more ARVs can be given out if nurses are allowed to prescribe them.

South Africa has more healthcare workers who are better paid in comparison, but there is unequal distribution of health workers between the private and public sectors, and urban and rural areas. Combined with inadequate numbers of staff, this leads to delays in expanding treatment. -- Sapa