PMID- 20849626
OWN - NLM
STAT- MEDLINE
DCOM- 20110113
LR  - 20231103
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 10
DP  - 2010 Sep 17
TI  - Task sharing in Zambia: HIV service scale-up compounds the human resource crisis.
PG  - 272
LID - 10.1186/1472-6963-10-272 [doi]
AB  - BACKGROUND: Considerable attention has been given by policy makers and 
      researchers to the human resources for health crisis in Africa. However, little 
      attention has been paid to quantifying health facility-level trends in health 
      worker numbers, distribution and workload, despite growing demands on health 
      workers due to the availability of new funds for HIV/AIDS control scale-up. This 
      study analyses and reports trends in HIV and non-HIV ambulatory service workloads 
      on clinical staff in urban and rural district level facilities. METHODS: 
      Structured surveys of health facility managers, and health services covering 
      2005-07 were conducted in three districts of Zambia in 2008 (two urban and one 
      rural), to fill this evidence gap. Intra-facility analyses were conducted, 
      comparing trends in HIV and non-HIV service utilisation with staff trends. 
      RESULTS: Clinical staff (doctors, nurses and nurse-midwives, and clinical 
      officers) numbers and staff population densities fell slightly, with lower ratios 
      of staff to population in the rural district. The ratios of antenatal care and 
      family planning registrants to nurses/nurse-midwives were highest at baseline and 
      increased further at the rural facilities over the three years, while daily 
      outpatient department (OPD) workload in urban facilities fell below that in rural 
      facilities. HIV workload, as measured by numbers of clients receiving 
      antiretroviral treatment (ART) and prevention of mother to child transmission 
      (PMTCT) per facility staff member, was highest in the capital city, but increased 
      rapidly in all three districts. The analysis suggests evidence of task sharing, 
      in that staff designated by managers as ART and PMTCT workers made up a higher 
      proportion of frontline service providers by 2007. CONCLUSIONS: This analysis of 
      workforce patterns across 30 facilities in three districts of Zambia illustrates 
      that the remarkable achievements in scaling-up HIV/AIDS service delivery has been 
      on the back of sustained non-HIV workload levels, increasing HIV workload and 
      stagnant health worker numbers. The findings are based on an analysis of routine 
      data that are available to district and national managers. Mixed methods research 
      is needed, combining quantitative analyses of routine health information with 
      follow-up qualitative interviews, to explore and explain workload changes, and to 
      identify and measure where problems are most acute, so that decision makers can 
      respond appropriately. This study provides quantitative evidence of a human 
      resource crisis in health facilities in Zambia, which may be more acute in rural 
      areas.
FAU - Walsh, Aisling
AU  - Walsh A
AD  - Department of Epidemiology and Public Health Medicine, Division of Population 
      Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland. 
      aislingwalsh@rcsi.ie
FAU - Ndubani, Phillimon
AU  - Ndubani P
FAU - Simbaya, Joseph
AU  - Simbaya J
FAU - Dicker, Patrick
AU  - Dicker P
FAU - Brugha, Ruairi
AU  - Brugha R
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20100917
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - Acquired Immunodeficiency Syndrome/diagnosis/drug therapy/epidemiology
MH  - *Ambulatory Care
MH  - Anti-HIV Agents/*administration & dosage
MH  - Female
MH  - Government Programs
MH  - HIV Infections/diagnosis/*drug therapy/*epidemiology
MH  - HIV Seropositivity
MH  - Health Care Surveys
MH  - Health Services Accessibility
MH  - Health Workforce/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Needs Assessment
MH  - Politics
MH  - Poverty
MH  - Risk Assessment
MH  - Rural Population
MH  - Staff Development
MH  - Urban Population
MH  - *Workload
MH  - Zambia/epidemiology
PMC - PMC2955013
EDAT- 2010/09/21 06:00
MHDA- 2011/01/14 06:00
PMCR- 2010/09/17
CRDT- 2010/09/21 06:00
PHST- 2009/12/03 00:00 [received]
PHST- 2010/09/17 00:00 [accepted]
PHST- 2010/09/21 06:00 [entrez]
PHST- 2010/09/21 06:00 [pubmed]
PHST- 2011/01/14 06:00 [medline]
PHST- 2010/09/17 00:00 [pmc-release]
AID - 1472-6963-10-272 [pii]
AID - 10.1186/1472-6963-10-272 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2010 Sep 17;10:272. doi: 10.1186/1472-6963-10-272.