Treatment Monitor: Focus on Human Resources
With the advent of cheaper drugs, the debates on systems factors affecting HIV/AIDS care are increasingly shifting to questions of how HIV services can be staffed in low-income settings. These debates are informed by a rapidly worsening human resource crisis, which is driven by a brain drain from low-income countries, increasing morbidity and mortality among health workers and rapidly increasing service demands.
Recent research provides insight into systems and particularly staffing requirements for the treatment of AIDS. In general, these articles focus on the human resource implications of rendering anti-retroviral treatment to large under-serviced and often hard to reach populations. Much less attention is paid to the myriad of other care requirements, from counseling and testing to nutrition support, treatment of OIs, PMTCT and home-based care, palliative care and household support which often place enormous strains on health services and human resources long before ARVs arrive. Virtually all aspects of care, except initial ART and some medical follow-up, is routinely expected to be rendered by nurses, mid-level and community-based workers. This key response often borne out of necessity in downward ‘task shifting’ of duties to lower level providers has become a key policy area.
Since the early 1990’s several policies have impacted on nursing in South Africa. Firstly the move towards rendering primary health care relies more extensively on nurses as the main service provider, and has resulted in nurses taking on more responsibility for managing and providing health services. Increased access and utilisation of health services as a result of the provision of free health care for pregnant women and children and other improvements in access, has in some areas also increased the workload of nurses. The increasing burden of disease due to HIV and TB, and the range of new interventions to prevent and treat HIV and AIDS have further impacted on nurses' work. The new National Strategic Plan for HIV and AIDs in South Africa, will rely extensively on ‘task shifting’ of functions to other cadres of health workers to meet the n short supply of nurses in order to ensure that the health system is able to meet the demands for prevention and care. The policy and regulatory framework for this is still to be addressed.
Nurses also increasingly have to manage new categories of lay health workers and mid level health workers. These categories are intended to relieve the pressure on nurses, but also present new responsibilities and challenges in terms of the management and supervisory roles of nurses.
Whilst the scope of work and levels of responsibility of nurses has expanded, the numbers of nurses available to undertake these new roles and work load has diminished. In the current year 36 % of public sector nursing posts in South Africa remain vacant. DENOSA notes that presently 30 members die each month due to natural causes who currently work in the public sector, and currently there are only 67 000 nurses registered with this COSATU affiliated trade union. Many of these nurses were already eligible for antiretroviral treatment but were not accessing treatment. Unless provided with the care they require, the attrition of nurses due to HIV and AIDS will further impact on the health system in the near future.
The Department of Health adopted a national Human Resources Plan for the health in 2006, which has focused attention and action around the human resources crisis in the health sector. As part of this plan steps are being taken to increase the numbers of nurses training. There is also now an expressed intention to increase funding for nursing posts and provision to be made for an occupation –specific dispensation which would address nurses salaries amongst others.
There are key areas of work that are being prohibited due to policy and regulatory barriers. These include:
- Ethics/ Human rights around provider initiated testing
- Task shifting with nurses initiating HAART
- Routine testing with Community Health Workers being able to do finger prick tests, and
- Nurses being able to prescribe pain relief in palliative care.
- Workshop Report - HUMAN RESOURCES FOR HEALTH (HRH) AND THE NSP. 19 August 2008, The Birchwood Hotel and Conference Centre, Boksburg, Gauteng
- Nurses’ Response to the Goals of the National Strategic Plan in Cape Town, South Africa, 3 – 4 March 2009
- Research on the State of Nursing (RESON) Exploring nursing policies, practice and management in South Africa - Workshop Report, Dec 2008
- Creating awareness of womens issues. Women's health is under the spotlight this month and Nursing Update asked Marion Stevens, project manager of the Treatment Monitor at Health Systems Trust a few important questions. Nursing Update, September 2008
- DENOSA STRATEGIC CONSULTATION - TASK SHIFTING: considering legal and regulatory barriers 17 and 18 MARCH 2008. Report edited by: Marion Stevens, Frayne F Mathijs and Nombulelo Bomela