Emmanuel M. Makasa MD, MPH Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Emmanuel M. Makasa MD, MPH Zambia Medical Association Lusaka, Zambia emakasa@yahoo.co.uk Given to the Infectious Diseases Division of Brown University School of Medicine at Miriam Hospital, Providence RI, USA 21st May 2009

Describe healthcare system & infrastructure in Zambia. Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care OBJECTIVES: Describe healthcare system & infrastructure in Zambia. Discuss impact of HIV & effect on health sector. Examine interplay of human resource shortages & HIV care in Zambia. Relevance of human resources issue to ID in the USA A man ravaged by AIDS is bathed at a hospice in Zambia (www.Time.com)

Zambia’s location in the world: Country Profile: Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Zambia’s location in the world: Country Profile: Landmass ≈752,612 Sq Km Population – 12million Declining life expectancy @ birth of 37.5 years. High dependency ratio- 47% pop aged <15yrs. Fairly urbanized – 34.7% in urban areas. Administrative 9 provinces. Weak social economic position (among least developed) Democratic gov. (two 5 yr terms) Source:www.witiger.com

Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Zambia’s Healthcare System: Centralized (Ministry of Health) Three levels of healthcare. Free public healthcare for all. Small private sector. Inadequate funding (<15% of national budget) Zambia’s Healthcare Infrastructure: Inadequate & poor state of essential infrastructure, equipment & transport. Continued shortages & erratic supply of essential drugs & medical supplies. High disease burden with critical shortages of qualified health workers at all levels of health service delivery.

Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care

Zambia’s HIV/AIDS statistics & Response: Impact of HIV/AIDS on Zambia Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Zambia’s HIV/AIDS statistics & Response: 1, 100, 000 people living with HIV (Total Pop. 12 million) 15.2% Adult prevalence rate (15 – 49 yrs) 980,000 Adults living with HIV (15-49yrs) 560, 000 Women living with HIV (>15yrs) 95,000 children living with HIV (0 – 14yrs) 56, 000 Deaths due to AIDS 600,000 Orphans due to Aids (0 – 17yrs) Impact of HIV/AIDS on Zambia General: Retarded national development Disrupted extended family system Lowered life expectancy to 37.5 yrs On Health Sector: Increase disease burden Shortages of health facilities, supplies & staff Morbidity and mortality of health workers from AIDS NOTE: Impact worse in rural areas Source: Epidemiological Fact Sheet on HIV & AIDS, 2008

Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Progress towards universal access: Source: Ministry of Health, Zambia

Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care

Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care

Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Source: Ministry of Health, Zambia

Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care

Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care

Inadequate & poor state of Health infrastructure and medical supplies Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Impact of HIV/AIDS and Human Resource Shortages on Zambia’s healthcare delivery. HIV/AIDS + Malaria & TB Increased Disease Burden Inadequate & poor state of Health infrastructure and medical supplies Healthcare Delivery in Crisis HRH Weak Retention Death from AIDS Inadequate training Human Resources for Health Shortages

Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care The way forward: Make human resources for health a priority in the fight against the HIV/AIDS. Rural areas of Zambia should NOT be ignored as they are affected the most. Although we need help as a country from international partners to build capacity, our future lies in our own hands. Need for more Zambian political will and commitment to overcome the challenges we face.

What does this mean for you: Practice & do research abroad? Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care What does this mean for you: Practice & do research abroad? - Awareness of situation helpful. -Human resource issues should be part of research. How does the Zambian situation affect you & your careers? - While there are opportunities for short term work, long term work is what is needed the most. - The role of teaching and training locals should also be a priority. Without tackling this issue, your work in trying to fight HIV, especially in Africa, is greatly held back . Thus far I have given you an overview of just how important and crucial this human resource shortage is in Zambia, especially as it pertains to the fight against HIV/AIDS, TB etc. However, more importantly ,I’d like to touch on what this crisis means for you. First, understand that this situation is not unique to Zambia. This crisis exists throughout Africa, and extends in various capacities to other developing countries around the world. As such, it affects the work that you are trying to do in fighting HIV. Most of the clinical/research work done by American physicians in Africa is centered around treating and controlling infectious diseases. So, especially for those who are interested in either practicing or doing research in Africa, awareness of this situation is important. The work done by western doctors in Africa to fight infectious disease is directly affected by this crisis. Thus, working to fight the human resource issue should also be a part of any health care work you do in Africa. There are several opportunities for short term work for infectious disease doctors in Africa. However, in order to effectively deal with the disease burden in Zambia, long term commitment is required. In addition to the clinical work western doctors can do in Africa, the role of teaching and training locals (capacity building) should also be a priority. This would ensure that any progress that is made by you in Africa is sustainable. Just to reiterate, as you think about how best to fight infectious disease in Africa, remember the human resource issue. Without tackling this issue, your work in trying to fight HIV and other infectious diseases, especially in Africa, will be greatly held back.

Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care Acknowledgements: Division of Infectious Diseases Dr. Flanigan, ID Division Chair Susan M. Tootell & Dalila Zachary All of you for attending

Human Resource Shortages in the Zambian Health Sector & its Impact on HIV/AIDS care References: World Health Organization. The World Health Report 2006 – Working together for health. UNAIDS. Zambia – Country Response. Available at: http://www.unaids.org/en/CountryResponses/Countries/zambia.asp. Accessed May 19 2009. Makasa E. The Human Resources crisis in the Zambian Health Sector – a discussion paper. Med J Zambia 2008;35(3) 81-87. Ministry of Health of Zambia. Joint Annual Review for 2007 Main Report. Available at: http://www.moh.gov.zm/?q=node/publications. Accessed May 19 2009. Ministry of Health of Zambia. National Strategic Plan 2006-2010. Available at: http://www.moh.gov.zm/?q=node/publications. Accessed May 19 2009. Central Statistics Office Zambia. Main Zambia Census Report 2000. Available at: http://www.zamstats.gov.zm/census.php. Accessed May 19 2009.