1. International Health Policy Program -Thailand Thidaporn Jirawattanapisal, Writeshop, Mahidol University, 29 July 2009 IPSR writeshop, Salaya Pavillion, Mahidol University, 22-29 July 2009 Workforce burden of universal access to HIV/AIDS treatment in Thailand from 2008 to 2015 Thidaporn Jirawattanapisal

2. International Health Policy Program -Thailand Thidaporn Jirawattanapisal, Writeshop, Mahidol University, 29 July 2009 2 Introduction  Thailand has committed to the world to provide universal coverage to treat HIV/AIDS in the country since 2003.  Since 2008, Thai health care system currently provides comprehensive treatment and care for over 100,000 patients  WHO and UNAIDS estimate: By 2015 Thailand would need to scale-up ART for 285,000 PLWHAs (3 times its current coverage !!!)  To achieve this goal even while taking into account future growth in health care provision and personnel may increase not only Economic burdens, but workload burdens significantly.  This may present challenges for sustaining prevention and scaling up ART program.

3. International Health Policy Program -Thailand Thidaporn Jirawattanapisal, Writeshop, Mahidol University, 29 July 2009 3 Backgrounds  Although this burden is similar across countries, the level appears to vary a lot:  Some countries the increase in the burden is only 1.5 times and in other places the increased burden on personnel is more than 3 times  Previous studies of HIV/AIDS treatment services have been shown to be successful, but have not evaluated workload !!! So what !!! Why we need to study ?

4. International Health Policy Program -Thailand Thidaporn Jirawattanapisal, Writeshop, Mahidol University, 29 July 2009 4 Research question  How much burden are Thai health care personnel to treat HIV/AIDS from 2008 to 2015 ?  How & Why different (Or similar) in the health care burden in Thailand and in other countries ?  This study will assess workload impacts resulting from added HIV/AIDS treatment protocols  Offers the first study of its kind  Provides comparative insights for other settings What we would like to know?

5. International Health Policy Program -Thailand Thidaporn Jirawattanapisal, Writeshop, Mahidol University, 29 July 2009 5 Methods  Data collecting  number of PLWHAs in 2008 from National database  number of health care professionals from the 3 previous studies for the medical doctors, nurses, and pharmacists.  (Apply for counselors and Lab.Technicians)  Data analyzes : Observational and interview data from three hospitals and 15 professionals responsible for ART services  Time required for services :3 types of patients ( Initiation, F/U w(+) Complication  Number of PLWHAs: classified by 3 types of patients and was projected from 2008 to 2015  FTEs required by 5 cadres of health professions (staff works 220 days / annum, 6 hrs / day) and their proportion of professions for services.

6. International Health Policy Program -Thailand Thidaporn Jirawattanapisal, Writeshop, Mahidol University, 29 July 2009 6 Results

7. International Health Policy Program -Thailand Thidaporn Jirawattanapisal, Writeshop, Mahidol University, 29 July 2009 7 Results

8. International Health Policy Program -Thailand Thidaporn Jirawattanapisal, Writeshop, Mahidol University, 29 July 2009 8 Proportion of Professional availability (%)

9. International Health Policy Program -Thailand Thidaporn Jirawattanapisal, Writeshop, Mahidol University, 29 July 2009 9 Conclusion Findings indicate that there is not much workload increase I n 2008: 2.5 to 4.5 FTEs/1,000 PLWHAs In 2015: 2.8 FTEs/ 1,000 PLWHAs  Cambodia, in 2008: 2.06 FTEs per 1,000 PLWHAs Proportion of available professions/ total PLWHAs Counselor: 1.5- 2.0 % (/ total PLWHAs in a year) Others professionals: 0.2-1.2 % (/ total PLWHAs in a year )  Malawi, in 2004: 13.7% (physicians), 1.1% (nurses)

10. International Health Policy Program -Thailand Thidaporn Jirawattanapisal, Writeshop, Mahidol University, 29 July 2009 10 Discussions Thailand has pluralistic and effective the health care system to provide universal access of ART services. Adequate health system and early prevention were claimed The infrastructure supports such hospitals and clinics avail for the services However, there is not much increase in workload burden and proposes how the burden may be more emotional !!!  Further study: Intensive study  To find number of health care personnel : closer to the real situation and more studies of projection of counselor and Lab  In more detail of parameters : different type of patients, different service activity (different style to provide the services) May be reasonable to be emotional !!!