Ethiopian AIDS response as a lever
to expand the health workforce &
services
Yibeltal Assefa
([email protected])
Tamrat Assefa
( [email protected] )
IAS 2010 HIV and health systems
pre-conference meeting
July 16-17
Vienna
Outline of the presentation
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Background
HIV/AIDS situation in Ethiopia
HRH situation in Ethiopia
The response
Conclusion
Country background
• Total population 80
million
• Population growth
2.7% / year
• Rural population
83.9%
• Life expectancy
M 53.4 F 55.4
• IMR 77/1,000 LBs
• MMR 673/100,000
LBs
• Total health
expenditure 4.4 % of
GDP
HIV/AIDS situation in Ethiopia
• 2.3 % HIV prevalence (Urban 7. 7% and
rural 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 students
intend to migrate
– Number doctors in private sector doubled between
2001 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 private
and 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
3,000
35,000
30,000
2,500
25,000
2,000
20,000
1,500
15,000
1,000
10,000
500
5,000
0
0
2005
2006
{MD}
2007
HO
MW
2008
Nurse
2009
HEW
Innovative approaches to scale
up 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 mid
and 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 to
nurses
• Type III: from nurses to community health
workers such as
– Health extension workers
– Case managers
– Community counselors
• Type IV: from nurses to patients: patient selfmanagement
Number of HF
providing HCT
HCT services
scale-up
1800
6,000,000
5,304,231
1600
1573
1400
5,000,000
4,559,954
1336
1200
4,000,000
1005
1000
3,000,000
800
600
775
658
1,922,667
2,000,000
400
1,000,000
200
436,854
0
564,350
0
2005
2006
2007
2008
2009
2005
2006
2007
2008
2009
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
Beyond the AIDS response
Trends in Health service coverage
indicators, (2006-2009) Ethiopia
Percentage
The number of Hospitals and Health
centres across the years (1994-2008),
Ethiopia
90
80
70
60
50
40
30
20
10
0
2006
2007
2008
2009
Year
{ANC}
{Immunization}
{CAR}
Conclusion
• Ethiopia is one of the countries with critical shortage
of 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-up
HIV/AIDS and other health services towards
universal access through task shifting
Thank You
Acknowledgements:
ITM (Wim Van Damme, Luc Van Leemput,
Freya Rasschaert)
IAS, ICAP, GF, RF