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Strengthening HR Capacity to Address the HIV Crisis
Dr. Mphu Ramatlapeng
Minister of Health, Lesotho
2 February 2012
Father Michael Kelly Lecture
Presentation Outline
• Overview of HRH in the Developing World
• Lesotho’s Case
o Country Overview
o HRH Status
o Interventions
o Results
o Looking Forward
In the developing world, especially Africa, health worker to population ratios are much lower than in the developed world
Number of Health Workers (Doctors, Nurses, Midwives) Per 1,000 People By Region
Source: Conway M.D. et al, “Addressing Africa’s health workforce crisis,” McKinsey Quarterly, November 2007
World Health Organization’s recommended minimum ratio of 2.5 health workers per 1,000 people
Africa, more than any other region, bears a disproportionate percentage of disease burden relative to its health workforce
% of Global Workforce
Distribution of Health Workers By Level of Health Expenditure and Disease Burden
Source: World Health Organization. World health report 2006: working together for health. Geneva: WHO; 2006.
Health workers are distributed unevenly - Africa suffers more than 24% of the global burden of disease but has access to only 3% of health workers
Note: Size of dots represent health
expenditure
% o
f Glo
bal B
urde
n of
Dis
ease
The Kingdom of Lesotho is a landlocked country within South Africa characterized by mountainous terrain
• Population of ~2 million• 10 districts; 30,355 sq km• 1/3 of land is lowlands; 2/3 are
foothills and mountainous regions• Sesotho and English spoken• Parliamentary Constitutional
Monarchy• Domestic economy comprises
manufacturing (e.g. textiles), diamonds, agriculture
Lesotho At a Glance
Lesotho’s HIV burden is among the highest in the world
HIV/AIDS Statistics
HIV Prevalence 23.1%
People Living with HIV/AIDS
290,000-235,000 adults-37,000 children
People Needing ART138,000
-115,000 adults-23,000 children
People On ART84,974
-79,331 adults-5,643 children
HIV+ Pregnant Women Per Year ~15,200
PMTCT Coverage 81%
Source: 2011 Lesotho MOHSW Annual Joint Review
• 3rd highest HIV prevalence in the world
• Maternal mortality rate: o 1,155 per 100,000 live births
• Infant mortality rate: o 91 per 1,000 live births
Lesotho faces a shortage of nurses that contributes to the prevention of achievement of health related MDGs
Source: 2011 Nursing Education Partnership Initiative (NEPI) MOHSW Lesotho Assessment
Projected Versus Target Nurse Numbers
Num
ber o
f Nur
ses
• Nursing/midwifery targets set using WHO recommended minimum threshold (1.73 nurses/midwives per 1000 people) to achieve MDGs
Target Numbers
Projected Numbers
Lesotho introduced several interventions with the support of key partners, including Irish Aid
Nursing Initiative
Mentoring: Clinical and Laboratory
Access to Medicines
Rural Initiative
• Support for 150 nurses enabled de-centralization of health care services• Early adopter of task-shifting ART initiation to nurses
• Mentoring enabled built capacity to provide high quality services• Clinical: Over 600 healthcare workers have received mentoring• Lab: Mentorship enabled first SLMTA (Strengthening Laboratory Management
Towards Accreditation) graduates in Africa
• Supply chain management support enabled HR to provide HIV care and treatment
• Lesotho Flying Doctors Services clinics serve a population of ~100,000• Over 5,500 patients enrolled on ART since inception of program
Irish Aid Contribution: €16.4m - 2010
Over time, health centers in the most rural areas of Lesotho have experienced dramatic improvements in service offerings
•Over a hundred thousand people use these clinics as their primary source of health care
•~50,000 people have accessed HIV testing and counselling services at the seven centres with Partners In Health support
•5,500+ patients have been enrolled on ART at the seven centres with Partners In Health support
•In many cases patients travel for over two days to access health services at these clinics
Data as per end of 2010, the last year from which data is currently available
Additionally, the numbers of adults and children on ART have consistently increased, in part due to strengthened HR
Source: Lesotho MOHSW Annual Joint Review Data
Adul
ts o
n AR
T
Child
ren
on A
RT
Moving forward, a number of initiatives are planned to further strengthen HR capacity in Lesotho
Nursing Education Partnership Initiative (NEPI)
Medical School
• Supports creation and sustainability of quality, innovative nursing education models
• Supports finite bundle of interventions in individual nursing schools
• 40 Basotho students currently studying in Zimbabwe
• Students will return to Lesotho to finish three years of training at newly constructed training facility