MOZAMBIQUE: Health worker shortage hinders AIDS response

Vilanculos, 6 April 2007 (PlusNews) - After a 15-hour journey, retired military officer Teofilo Afonso arrives at the hospital in Vilanculos, a tourist town in the province of Inhambane, where he receives treatment for HIV. He will wait a further five hours before being attended to. Just two doctors staff the hospital, which serves four districts - Vilanculos, Mabote, Govuro, and Inhassoro.

Meanwhile, at the Central Hospital in the capital, Maputo, nurse Alberto Frederico (not his real name) told IRIN/PlusNews that because of AIDS, "we are getting extremely crowded and stretched thin. The treatment that we give can't be the best because of the pressure and because there aren't enough people to deal with the influx of patients."

With one full-time doctor, four part-time doctors, and 10 nurses, Central Hospital's AIDS clinic treated 2,900 patients last year. The clinic lacks the equipment to determine viral load [the amount of HIV in the blood] or medication to treat some AIDS-related illnesses, and staff still rely on a paper-based system to keep track of patients.

The situation in Vilanculos and Maputo reflects the state of public health in the country, in which lack of manpower and resources are hindering the HIV/AIDS response.

Mozambique has just 650 doctors and 4,220 nurses to cater for a population of 19.8 million with an adult HIV prevalence of 16.1 percent. This equates to one doctor for every 30,800 people, when the World Health Organization (WHO) recommends one doctor for every 10,000.

"The deficit of trained people is significant in every area, but in health the deficit is huge," commented Josue Lima, director of the national office of the International Centre for AIDS Care and Treatment Programmes.

Isabelle Segui-Bitz, president of Medecins Sans Frontieres (MSF)-Switzerland, one of the biggest providers of antiretroviral (ARV) treatment in the country, confirmed that the lack of trained health professionals has made the expansion of ARV treatment difficult.

There is such extreme crowding of rooms and beds in our hospitals that we can't manage to attend to every patient

The shortage of doctors means that at many health centres, HIV testing and treatment is conducted by nurses and paramedics. A lack of pharmacists means that nurses also dispense 80 percent of medications. According to a 2006 UNAIDS report, nurses are overwhelmed by work and stress.

In the central province of Tete, Joao Fortuna, HIV/AIDS manager in the Provincial Health Directorate, said, "there is such extreme crowding of rooms and beds in our hospitals that we can't manage to attend to every patient."

At the Tete Day Hospital, which specializes in HIV/AIDS, Fortuna noted that staff are rarely able to "clock out at the expected hour" due to the backlog of patients. "You can't close the doors with patients waiting," he said.

Dr Azelia Ernesto Novela, a specialist in endemic diseases at the Provincial Health Directorate, said that the number of health workers currently working in the province was about half of what was needed. Only four out of Tete’s 13 districts have doctors and they are often tied up with bureaucratic matters associated with the running of health centres.

"Each district should have at least two doctors," said Novela.

Compounding the problem are the numbers of health professionals who themselves have AIDS-related illnesses. According to research conducted by the Ministry of Health in 2002, around 17 percent of workers in the national health system were infected with HIV.

"AIDS is going to cause the loss of many workers in this sector," predicted Dr Alfredo Mac-Arthur Junior, head of the Ministry of Health's epidemiology and endemic diseases department.

According to a WHO global report, published in November 2006, "the devastating impact of the HIV/AIDS pandemic has drastically cut large swathes of the health workforce in some African countries". Between 1999 and 2005, Botswana lost 17 percent of its health professionals due to AIDS and in Lesotho and in Malawi, death is the principal reason for the loss of health personnel.

Not meeting demand

The training of new professionals can't keep up either with the loss of personnel to AIDS or with the growing demand for healthcare.

According to Mac-Arthur, the destruction and neglect of nursing and medical schools during the civil war that ended in 1992, has hampered the training of more professionals. The 11 institutions that train medical technicians have already exceeded their capacity and there are just two medical schools in the country. The older one, Eduardo Mondlane University, graduates fewer than 50 doctors per year, while the other, which opened just a few years ago in the coastal city of Beira, still hasn't graduated its first class.

Reducing the length of a medical degree from seven to six years has not been enough to significantly increase the number of new doctors. Another strategy of recruiting retired health workers has had limited success, because of the low government salaries on offer, said Mac-Arthur.

A doctor earns about 12,000 Meticais (US$460) per month and nurses on average earn 6,000 (US$230).

"It pays badly and this discourages young people to get into medicine or nursing. The government has to make the health sector an attractive thing to get into," said Frederico, the nurse from Maputo.

Wealthy countries offer better opportunities. At least 22 Mozambican doctors are working in developed countries - almost four percent of all the doctors in Mozambique, according to the WHO report.

Community involvement

AIDS organisations in Mozambique are creating their own community-based solutions to deal with the health worker shortage.

In Tete, to free up beds for the worst cases, patients in less grave condition are released from the hospital and provided with home-based care.

The MSF-Switzerland programme in the Alto Mae Hospital in Maputo trains community members to assist nurses with patients and to distribute ARVs.

Theme (s): Care/Treatment - PlusNews,

[This report does not necessarily reflect the views of the United Nations]