Abstract #210  -  The impact of ART scale up on health workers: evidence from two South African districts
Authors:   Presenting Author:   Mr Gavin George - Health Economics and HIV/AIDS Division (HEARD)
Additional Authors:  Ms Millicent Atujuna, Prof Timothy Quinlan, Ms Candice  Meyer,
Aim: Human resource capacity is commonly identified as the most significant health system component in efforts to expand antiretroviral treatment programmes, but the links between the two are not precisely defined. From the perspective of work motivation, this study aims to isolate and define how scale up affects the capacity of the health workforce in South Africa and suggests practical strategies for delivering scaled up treatment.
Method / Issue: The data two sites in South Africa: the Ilembe district in KwaZulu-Natal province and the Cape Winelands Region in the Western Cape province. Twenty-one health care professionals were interviewed across the two sites in order to determine their perspectives on the impacts of ART scale-up. Furthermore a self –reported Likert scale questionnaire on working conditions was administered to a randomly selected cohort of ART and non-ART health professionals at service delivery sites in KwaZulu Natal and Western Cape provinces of South Africa. A total of 269 health personnel were interviewed, 44.6% (120/269) of whom were ART workers.
Results / Comments: Health workers involved in providing ART and in scaling up the service would be demoralized in light of previous research. Study survey data showed higher morale (60.82% ART compared to 39.18% of Non ART professionals), with statistically significant differences between the two groups (H=9.09, 2d.f. P=0.016). Furthermore, a number of ART professionals interviewed emphasized that their ability to provide treatment to HIV positive patients impacted positively on morale. Existing research concludes that staff in the ART programmes experience increased caseloads and, more generally, higher workloads in hospitals and clinics as a result of the increasing number of patients beginning to receive treatment. Our data concurred with both ART and Non-ART health professionals indicating increased loads. However, among ART professionals, ability to give patients hope and allow them to lead a normal life again seemed to compensate for work stress. Additionally, ART professionals reported lesser negative effects on the capacity of staff than Non-ART professionals reported for general health care. Indeed, statistically, the results suggested an increase in human resource capacity (H=10, 2d.f. P=0.0047).
Discussion: ART programmes in the areas where research was done, showed increase in overall staff motivation and satisfaction. The scale up of ART programmes undeniably puts pressure on staff at health facilities but for ART professionals in particular, these are mitigated by the benefits arising from being able to treat AIDS patients. A Sub-issue which emerged from the data is that ART scale up programmes created two separate streams of facilities for health workers, the effects of which suggest far greater impacts to be revealed in future.
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