Ethiopian AIDS response as a leverto expand the health workforce &services
IAS 2010 HIV and health systemspre-conference meeting
July 16-17
Vienna
Outline of the presentation
•Background
•HIV/AIDS situation in Ethiopia
•HRH situation in Ethiopia
•The response
•Conclusion
Country background
•Total population 80million
•Population growth2.7% / year
•Rural population
83.9%
•Life expectancy
M 53.4 F 55.4
•IMR 77/1,000 LBs
•MMR 673/100,000LBs
•Total healthexpenditure 4.4 % ofGDP
HIV/AIDS situation in Ethiopia
•2.3 % HIV prevalence (Urban 7. 7% andrural 0.9%)
•1.1 million PLWHA
•336,160 in need ART
•125,000 new infections in 2009
HRH situation in Ethiopia
Health workforce density and distribution
•Total 66,314 health workers (50% HEWs)
•0.7 health workers/1,000 populations(2.3/1000)
•1 doctor/ 43,000 population (2/10000)
•37% of doctors working in Addis Ababa
(3.7% pop)
•1 Nurse/ 5,000 population (1/5000)
HRH situation in Ethiopia: challenges
•Health workforce migration
(external & internal brain drain)
–2002, ± 17% nurses and 30% doctors left country
–72% medical students and 62% nursing studentsintend to migrate
–Number doctors in private sector doubled between2001 and 2009
•Financing of health workforce
•Educational system for HRH
•HRH management
Recognition of HRH crisis triggered by AIDS crisis
The concerted effort(Government & partners)
Short term - task shifting
Long term strategies
•Rapid increase in the # of medical schools both privateand public (from 3 in 2005 to more than 10 in 2009)
•Rapid increase in the output of MDs, HOs & nurses
Speciality trainings
•Master in public health & other specialties
•Master of Science in Emergency surgery & obstetrics
•HMIS diplomas
•Master in Hospital and health care management
Development of HRD strategy
Mainly supported by PEPFAR, DFID and GFATM
Trend of health workers in Ethiopia
MD,HO, MW
Nurse, HEWs
Innovative approaches to scaleup HIV/AIDS services
•The public health approach
–Standardization and simplification
–Task shifting
–Decentralization
–Free service at the point of delivery
Task shifting as emergency response
•Universal access with doctor-based model– need 2.5 x more Doctors
•Lag time to produce doctors 6-7 years; so,many patients would have died
•adequate number of nurses, 18,000
•Studies in the west/north showed that midand low level cadres can do the job
Types of task shifting in Ethiopia
•Type I: from doctors to health officers
•Type II: from doctors and health officers tonurses
•Type III: from nurses to community healthworkers such as
–Health extension workers
–Case managers
–Community counselors
•Type IV: from nurses to patients: patient self-management
Number of HFproviding HCT
HCT servicesscale-up
ART scale-up, 2004 - 2009
Indicator
End 2004
End 2009
ART need
242,453
336,160
ART provided
9000
174,492
% coverage
3.7%
52%
Women
25%
52%
Children
1%
5%
Addis Ababa
75%
25%
AIDS mortality
99,360
44,751
Challenges
•Retention mechanisms for health workers
•Preventive services not well developed
•Retaining patients on treatment
The number of Hospitals and Healthcentres across the years (1994-2008),Ethiopia
Beyond the AIDS response
Trends in Health service coverageindicators, (2006-2009) Ethiopia
Conclusion
•Ethiopia is one of the countries with critical shortageof HRH, mainly clinicians
•Recognition of HRH crisis triggered by AIDS crisis
•AIDS intervention as a lever for HRH development
•The role of community health workers revitalised
•Despite the HRH crisis, Ethiopia is able to scale-upHIV/AIDS and other health services towardsuniversal access through task shifting
Thank YouThank You
Acknowledgements:
ITM (Wim Van Damme, Luc Van Leemput,Freya Rasschaert)
IAS, ICAP, GF, RF