Your daily Selection of IRIN Africa PlusNews reports, 11/17/2006

[Guest guest]

U N I T E D N A T I O N S

Office for the Coordination of Humanitarian Affairs

Integrated Regional Information Network (IRIN) -

[These reports do not necessarily reflect the views of the United Nations]

CONTENT:

1 - MALAWI: Health worker shortage a challenge to AIDS treatment

2 - SWAZILAND: Students ignore safer sex practices, survey finds

1 - MALAWI: Health worker shortage a challenge to AIDS treatment

NKHATA BAY, 17 November (PLUSNEWS) - Nafere has just finished a long night

shift as the only nurse tending to 80 patients spread across two wards at Nkhata

Bay Hospital in northern Malawi.

She is one of just 18 nurses, five clinical officers and one doctor that staff

this district hospital, where the ARV clinic alone provides treatment to 926

patients.

" Each ward is supposed to have three or four nurses, and one nurse is supposed

to attend to 10 to 12 patients a day, " said Nafere. " But here one nurse is

attending to more than 100 patients a day. Do you think she can provide good

services? "

The shortage of healthcare workers is a global crisis, but developed countries

can afford to throw money at the problem, attracting nurses and doctors from

developing countries with vastly better salaries and working conditions.

While the HIV/AIDS epidemic has multiplied the need for doctors and nurses in

southern Africa, the pool of workers has shrunk. Those remaining in their

countries face a daily, demoralising struggle to manage impossibly heavy patient

loads with scare resources. Many take their skills to the private or NGO sectors

or flee the profession altogether. An unknown number of others have succumbed to

the disease (see sidebar).

In Malawi, the fourth poorest country in the world, where UNAIDS has put HIV

prevalence at 14 percent, the health worker shortage is so acute that the

ministry of health and international donors are now treating it as an emergency.

" There is a profound human resources crisis in this country, " said Dr

O'Carroll, a technical advisor the government has appointed to oversee a

six-year US$275 million plan to address the problem. " The World Health

Organisation says no developing nation can expect to go anywhere without a ratio

of one physician to 5,000 of the population. We have one doctor per 60,000,

which puts us in one of the worst situations in the world. "

Sixty-four percent of nursing posts in Malawi are unfilled and there are 100

doctors working in public hospitals serving a population of 12 million. Anyone

requiring the attention of a neurologist, dermatologist or a number of other

specialists must travel outside the country.<table width= " 240 " border= " 0 "

align= " right " cellpadding= " 8 " cellspacing= " 1 " style= " border: 1px solid #496EB5;

margin-left: 10px; " ><TR><TD bgcolor= " #AABBDC " align= " center " ><font size= " 2 "

face= " Arial, Helvetica, sans-serif " color= " #FFFFFF " ><b>The Human

Cost</b></font></td></tr><TR><TD bgcolor= " #AABBDC " style= " font-size: 9pt; " ><font

color= " #ffffff " >

There are plenty of reasons for Malawi's chronic health worker shortage. The

" poaching " of doctors and nurses by developed nations tends to get the most

attention. Less well-documented are the numbers of health workers who have died

from AIDS-related illnesses.

Alice Kadzanja, who has been nursing for 26 years, is one of only two in the

country who is open about her HIV-positive status. In the last 10 years she has

watched hundreds of colleagues succumb to the virus, in large part because of

the institutional stigma that prevented them from being tested or accessing

treatment, even when it was available.

" HIV has played a big role in the health worker shortage, " she said. " So many

staff have died. "

Over the years, Kadzanja has kept a count of the health workers she suspects

have been lost to the disease, and claims the number is in the region of 2,000.

She left the public sector in 2000, the same year she revealed her status, and

now works for Dignitas International, a Canadian NGO that runs the ARV clinic at

the district hospital in Zomba, about 70km east of Blantyre, in partnership with

government. The clinic opened in 2004 and currently provides treatment to 1,700

patients.

Despite a national policy of prioritising treatment for health workers,

according to Kadzanja, only 20 patients at Zomba are doctors or nurses. Dignitas

hopes that a new ARV clinic, opening soon and aimed specifically at health

workers, will reach them in greater numbers. The clinic will serve as a pilot

project and, if successful, will be replicated in other

districts.</font></td></tr></table>

District hospitals like Nkhata Bay, with an average of 250 beds, should have 175

nurses, said O'Carroll. None has more than 40. " That leads to some very serious

issues from a patient point of view, but also for the health workers themselves.

You have large numbers of people crying for services and you have nurses that

are on their feet 18 hours a day. It's a situation that creates an enormous

amount of tension, " he said.

Given the scale of the problem, it is something of a miracle that Malawi has

managed to keep its ambitious anti-AIDS treatment plan on target. As of the end

of September, 70,000 Malawians were accessing antiretroviral (ARV) treatment,

about 62,000 of them at public health services. According to the five-year plan,

an additional 40,000 patients will begin receiving treatment in 2007 and another

45,000 in each of the following three years.

Dr Bizwick Mwale, director of Malawi's National AIDS Commission, admitted that

human resources would be the biggest challenge.

In 2005, with funding from Britain's international development agency (DFID),

pubic healthcare workers received a 52 percent wage top-up and a campaign was

mounted to lure nurses back from the private sector. Money from the Global Fund

to Fight AIDS, Tuberculosis and Malaria is being used to expand the capacity of

Malawi's training institutions and provide extra incentives for health workers

in remote, rural areas.

Until these efforts yield results, some of the countries that have lured health

workers from Malawi are loaning their doctors to fill the gap. About 25 percent

to 30 percent of Malawi's doctors are sourced from overseas: some are United

Nations volunteers; others come with Britain's Voluntary Services International

or through agreements with European governments.

None of these measures is enough to keep pace with the additional 90,000

HIV-infected Malawians who need ARV treatment every year. As ARV clinics at

district hospitals rapidly reach their limit, the treatment programme will need

to roll out to smaller health centres, where qualified health workers are even

scarcer. The only way to move forward, said Mwale, was " to simplify the delivery

of ARV treatment " .

By developed world standards, Malawi's approach is fairly basic: clinics mainly

use diagnostic assessments rather than laboratory tests to determine when

patients are ready to begin treatment, and nearly 95 percent of patients are

prescribed the same combination of three drugs. After the first six months on

treatment, patients are only required to return to clinics once every two or

three months.

The next step is to train less qualified health workers to administer the drugs.

Rural health centres are usually staffed by one or two nurses and medical

assistants, and several health surveillance assistants (HSAs). HSAs are Malawi's

least qualified health workers.

Recruited locally, they receive just 10 weeks of training but are an invaluable

resource because of their close links with the community. There are 5,200 of

them, but the government plans to double that number and train about 1,000 of

the new recruits to work exclusively in HIV/AIDS. The eventual goal, explained

Mwale, is for HSAs to assist patients who merely need to receive their new drug

supplies.

Not everyone is comfortable with cutting corners when it comes to ARV treatment,

but no one can deny that the situation demands extreme measures.

" I'm quite worried about further and more rapid scale-up, given the human

resources restrictions we're facing, " said O'Carroll, " but we have life-saving

drugs and we're going to give them to as many people as we can, now. "

Nafere has no plans to leave Malawi for greener pastures, but so far she

has seen little evidence of the government's efforts to retain its health

workers: " Salaries for we Malawians are not adequate, but I can't leave my

relatives suffering here because of money, " she said. " If the government can

motivate us, if they can renovate our buildings and give us enough money, I

think we can improve, we can work happily. "

ks/oa/he

[ENDS]

2 - SWAZILAND: Students ignore safer sex practices, survey finds

MBABANE, 17 November (PLUSNEWS) - They should be smarter, but condoms are not

very popular among university students in Swaziland, which has the world's

highest HIV/AIDS prevalence rate, according to a new survey.

The study conducted over a two-year period beginning in 2004 by the University

of Swaziland into the sexual habits of students at its three campuses found that

safer sex practices, including condom use, were neglected by almost half the

interviewees. Up to 40 percent of the country's sexually active adults are HIV

positive.

" Participants pointed out that in many instances, female students do not

practice safe sex with their partners, " the survey by the university's research

board revealed, but did not provide a breakdown of safer sex practices according

to gender.

More than half the 432 students interviewed among the 5,000 spread over the

university's campuses in the capital, Mbabane, and outlying suburbs, were

female.

Just over 45 percent of the total said they " always " practiced safer sex,

although survey compilers cautioned that some of the students later admitted

forsaking condom use when their relationships with their partners became more

involved.

Male students led the revolt against condom use; female students would not

insist on condom use for fear of losing their boyfriends. A surprising number of

female students depended financially on their boyfriends. " Female students are

afraid that their partners would leave them in case they insist on condom use, "

the report commented.

One female student majoring in Social Science was quoted as saying, " I think

ladies always have this fear that if they refuse to do what he [the sexual

partner] is saying, they may lose him and he goes to somebody else. I think

there is always this element of fear - what if I lose him? Then you decide that

you should abide by what he says. "

The university distributes free condoms, but students criticised these as being

of " poor quality " .

Researchers said HIV/AIDS education and media campaigns have had little impact

on university students other than informing about the disease.

However, a recent study commissioned by the National Emergency Response Council

on HIV/AIDS found that awareness campaigns had contributed positively to

changing the sexual behaviour and attitudes of adult Swazis, which was reflected

in the number of people equating a new sexual partner with increased risk of HIV

infection: 92 percent in 2006, up from 87 percent in 2005.

The university survey recommended programmes and interventions aimed at

circumventing peer influences. It also suggested incorporating sex education

into the university curriculum, and establishing links with nongovernmental

health organisations that could provide HIV testing and counselling to students.

jh/jk/he/oa

[ENDS]

Your input is important. Please complete our annual survey at

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Principal donors: IRIN is generously supported by Australia, Canada, Denmark,

ECHO, Japan, Netherlands, Norway, Sweden, Switzerland, the United Kingdom and

the United States of America. For more information, go to:

http://www.IRINnews.org/donors

[This item comes to you via IRIN, a UN humanitarian news and information

service, but may not necessarily reflect the views of the United Nations or its

agencies. All IRIN material may be reposted or reprinted free-of-charge; refer

to the copyright page (Http://www.irinnews.org/copyright ) for conditions of

use. IRIN is a project of the UN Office for the Coordination of Humanitarian

Affairs.]

PLUSNEWS

Tel: +27 11 895-1900

Fax: +27 11 784-6759

Email: Mail@...

To make changes to or cancel your subscription visit:

http://www.irinnews.org/subscriptions

Subscriber: AIDS treatments

[Guest guest]

U N I T E D N A T I O N S

Office for the Coordination of Humanitarian Affairs

Integrated Regional Information Network (IRIN) -

[These reports do not necessarily reflect the views of the United Nations]

CONTENT:

1 - MALAWI: Health worker shortage a challenge to AIDS treatment

2 - SWAZILAND: Students ignore safer sex practices, survey finds

1 - MALAWI: Health worker shortage a challenge to AIDS treatment

NKHATA BAY, 17 November (PLUSNEWS) - Nafere has just finished a long night

shift as the only nurse tending to 80 patients spread across two wards at Nkhata

Bay Hospital in northern Malawi.

She is one of just 18 nurses, five clinical officers and one doctor that staff

this district hospital, where the ARV clinic alone provides treatment to 926

patients.

" Each ward is supposed to have three or four nurses, and one nurse is supposed

to attend to 10 to 12 patients a day, " said Nafere. " But here one nurse is

attending to more than 100 patients a day. Do you think she can provide good

services? "

The shortage of healthcare workers is a global crisis, but developed countries

can afford to throw money at the problem, attracting nurses and doctors from

developing countries with vastly better salaries and working conditions.

While the HIV/AIDS epidemic has multiplied the need for doctors and nurses in

southern Africa, the pool of workers has shrunk. Those remaining in their

countries face a daily, demoralising struggle to manage impossibly heavy patient

loads with scare resources. Many take their skills to the private or NGO sectors

or flee the profession altogether. An unknown number of others have succumbed to

the disease (see sidebar).

In Malawi, the fourth poorest country in the world, where UNAIDS has put HIV

prevalence at 14 percent, the health worker shortage is so acute that the

ministry of health and international donors are now treating it as an emergency.

" There is a profound human resources crisis in this country, " said Dr

O'Carroll, a technical advisor the government has appointed to oversee a

six-year US$275 million plan to address the problem. " The World Health

Organisation says no developing nation can expect to go anywhere without a ratio

of one physician to 5,000 of the population. We have one doctor per 60,000,

which puts us in one of the worst situations in the world. "

Sixty-four percent of nursing posts in Malawi are unfilled and there are 100

doctors working in public hospitals serving a population of 12 million. Anyone

requiring the attention of a neurologist, dermatologist or a number of other

specialists must travel outside the country.<table width= " 240 " border= " 0 "

align= " right " cellpadding= " 8 " cellspacing= " 1 " style= " border: 1px solid #496EB5;

margin-left: 10px; " ><TR><TD bgcolor= " #AABBDC " align= " center " ><font size= " 2 "

face= " Arial, Helvetica, sans-serif " color= " #FFFFFF " ><b>The Human

Cost</b></font></td></tr><TR><TD bgcolor= " #AABBDC " style= " font-size: 9pt; " ><font

color= " #ffffff " >

There are plenty of reasons for Malawi's chronic health worker shortage. The

" poaching " of doctors and nurses by developed nations tends to get the most

attention. Less well-documented are the numbers of health workers who have died

from AIDS-related illnesses.

Alice Kadzanja, who has been nursing for 26 years, is one of only two in the

country who is open about her HIV-positive status. In the last 10 years she has

watched hundreds of colleagues succumb to the virus, in large part because of

the institutional stigma that prevented them from being tested or accessing

treatment, even when it was available.

" HIV has played a big role in the health worker shortage, " she said. " So many

staff have died. "

Over the years, Kadzanja has kept a count of the health workers she suspects

have been lost to the disease, and claims the number is in the region of 2,000.

She left the public sector in 2000, the same year she revealed her status, and

now works for Dignitas International, a Canadian NGO that runs the ARV clinic at

the district hospital in Zomba, about 70km east of Blantyre, in partnership with

government. The clinic opened in 2004 and currently provides treatment to 1,700

patients.

Despite a national policy of prioritising treatment for health workers,

according to Kadzanja, only 20 patients at Zomba are doctors or nurses. Dignitas

hopes that a new ARV clinic, opening soon and aimed specifically at health

workers, will reach them in greater numbers. The clinic will serve as a pilot

project and, if successful, will be replicated in other

districts.</font></td></tr></table>

District hospitals like Nkhata Bay, with an average of 250 beds, should have 175

nurses, said O'Carroll. None has more than 40. " That leads to some very serious

issues from a patient point of view, but also for the health workers themselves.

You have large numbers of people crying for services and you have nurses that

are on their feet 18 hours a day. It's a situation that creates an enormous

amount of tension, " he said.

Given the scale of the problem, it is something of a miracle that Malawi has

managed to keep its ambitious anti-AIDS treatment plan on target. As of the end

of September, 70,000 Malawians were accessing antiretroviral (ARV) treatment,

about 62,000 of them at public health services. According to the five-year plan,

an additional 40,000 patients will begin receiving treatment in 2007 and another

45,000 in each of the following three years.

Dr Bizwick Mwale, director of Malawi's National AIDS Commission, admitted that

human resources would be the biggest challenge.

In 2005, with funding from Britain's international development agency (DFID),

pubic healthcare workers received a 52 percent wage top-up and a campaign was

mounted to lure nurses back from the private sector. Money from the Global Fund

to Fight AIDS, Tuberculosis and Malaria is being used to expand the capacity of

Malawi's training institutions and provide extra incentives for health workers

in remote, rural areas.

Until these efforts yield results, some of the countries that have lured health

workers from Malawi are loaning their doctors to fill the gap. About 25 percent

to 30 percent of Malawi's doctors are sourced from overseas: some are United

Nations volunteers; others come with Britain's Voluntary Services International

or through agreements with European governments.

None of these measures is enough to keep pace with the additional 90,000

HIV-infected Malawians who need ARV treatment every year. As ARV clinics at

district hospitals rapidly reach their limit, the treatment programme will need

to roll out to smaller health centres, where qualified health workers are even

scarcer. The only way to move forward, said Mwale, was " to simplify the delivery

of ARV treatment " .

By developed world standards, Malawi's approach is fairly basic: clinics mainly

use diagnostic assessments rather than laboratory tests to determine when

patients are ready to begin treatment, and nearly 95 percent of patients are

prescribed the same combination of three drugs. After the first six months on

treatment, patients are only required to return to clinics once every two or

three months.

The next step is to train less qualified health workers to administer the drugs.

Rural health centres are usually staffed by one or two nurses and medical

assistants, and several health surveillance assistants (HSAs). HSAs are Malawi's

least qualified health workers.

Recruited locally, they receive just 10 weeks of training but are an invaluable

resource because of their close links with the community. There are 5,200 of

them, but the government plans to double that number and train about 1,000 of

the new recruits to work exclusively in HIV/AIDS. The eventual goal, explained

Mwale, is for HSAs to assist patients who merely need to receive their new drug

supplies.

Not everyone is comfortable with cutting corners when it comes to ARV treatment,

but no one can deny that the situation demands extreme measures.

" I'm quite worried about further and more rapid scale-up, given the human

resources restrictions we're facing, " said O'Carroll, " but we have life-saving

drugs and we're going to give them to as many people as we can, now. "

Nafere has no plans to leave Malawi for greener pastures, but so far she

has seen little evidence of the government's efforts to retain its health

workers: " Salaries for we Malawians are not adequate, but I can't leave my

relatives suffering here because of money, " she said. " If the government can

motivate us, if they can renovate our buildings and give us enough money, I

think we can improve, we can work happily. "

ks/oa/he

[ENDS]

2 - SWAZILAND: Students ignore safer sex practices, survey finds

MBABANE, 17 November (PLUSNEWS) - They should be smarter, but condoms are not

very popular among university students in Swaziland, which has the world's

highest HIV/AIDS prevalence rate, according to a new survey.

The study conducted over a two-year period beginning in 2004 by the University

of Swaziland into the sexual habits of students at its three campuses found that

safer sex practices, including condom use, were neglected by almost half the

interviewees. Up to 40 percent of the country's sexually active adults are HIV

positive.

" Participants pointed out that in many instances, female students do not

practice safe sex with their partners, " the survey by the university's research

board revealed, but did not provide a breakdown of safer sex practices according

to gender.

More than half the 432 students interviewed among the 5,000 spread over the

university's campuses in the capital, Mbabane, and outlying suburbs, were

female.

Just over 45 percent of the total said they " always " practiced safer sex,

although survey compilers cautioned that some of the students later admitted

forsaking condom use when their relationships with their partners became more

involved.

Male students led the revolt against condom use; female students would not

insist on condom use for fear of losing their boyfriends. A surprising number of

female students depended financially on their boyfriends. " Female students are

afraid that their partners would leave them in case they insist on condom use, "

the report commented.

One female student majoring in Social Science was quoted as saying, " I think

ladies always have this fear that if they refuse to do what he [the sexual

partner] is saying, they may lose him and he goes to somebody else. I think

there is always this element of fear - what if I lose him? Then you decide that

you should abide by what he says. "

The university distributes free condoms, but students criticised these as being

of " poor quality " .

Researchers said HIV/AIDS education and media campaigns have had little impact

on university students other than informing about the disease.

However, a recent study commissioned by the National Emergency Response Council

on HIV/AIDS found that awareness campaigns had contributed positively to

changing the sexual behaviour and attitudes of adult Swazis, which was reflected

in the number of people equating a new sexual partner with increased risk of HIV

infection: 92 percent in 2006, up from 87 percent in 2005.

The university survey recommended programmes and interventions aimed at

circumventing peer influences. It also suggested incorporating sex education

into the university curriculum, and establishing links with nongovernmental

health organisations that could provide HIV testing and counselling to students.

jh/jk/he/oa

[ENDS]

Your input is important. Please complete our annual survey at

http://www.irinnews.org/readership_survey.aspThis is non-reply e-mail. Please do

not hesitate to contact us at Mail@....

Principal donors: IRIN is generously supported by Australia, Canada, Denmark,

ECHO, Japan, Netherlands, Norway, Sweden, Switzerland, the United Kingdom and

the United States of America. For more information, go to:

http://www.IRINnews.org/donors

[This item comes to you via IRIN, a UN humanitarian news and information

service, but may not necessarily reflect the views of the United Nations or its

agencies. All IRIN material may be reposted or reprinted free-of-charge; refer

to the copyright page (Http://www.irinnews.org/copyright ) for conditions of

use. IRIN is a project of the UN Office for the Coordination of Humanitarian

Affairs.]

PLUSNEWS

Tel: +27 11 895-1900

Fax: +27 11 784-6759

Email: Mail@...

To make changes to or cancel your subscription visit:

http://www.irinnews.org/subscriptions

Subscriber: AIDS treatments