Africa: Where to Find a Million New Nurses?

At the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town, South Africa, experts discussed ways to improve health systems and boost health care personnel in Africa.

"There are serious deficiencies in our health systems and without addressing the weaknesses, we cannot upscale" antiretroviral (ARV) treatment," said Jacqueline Bataringaya, senior policy adviser for IAS. "Yet, we need an additional 1 million doctors, nurses, and midwives in Africa."

Africa has long experienced a shortage of health care personnel and resources, with many who train there leaving for better pay in developed countries. World Health Organization figures show 37 percent of South Africa-trained doctors are working in the developed world, while South African nurses comprise almost a tenth of the nursing workforce in Australia, Canada, and the United Kingdom, among others.

In Malawi, well-trained community workers have taken on nursing responsibilities in homes and clinics to ease the workload of doctors and nurses, said Alan Whiteside, a researcher with the University of KwaZulu-Natal. "Task-shifting and community involvement are critical to fill the gap in skills and personnel," he said.

"The challenge here is how to institutionalize and remunerate these new workers and how to make them an integral part of the health system," said Wafaa El-Sadr, director of the International Center for AIDS Care and Treatment Programs.

Dr. Lipontso Makakole of Scott Hospital in western Lesotho described a nurse-initiated and -managed HIV care treatment program it instituted. Nurses were trained in clinical management skills to take over doctor-led tasks, while lay counselors were trained in adherence and ARV treatment preparation to free up nurses. "As a result, we initiated 37 percent more patients onto ARVs in 2008," while "80 percent of adults and 89 percent of children remained in HIV care," said Makakole.

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