Experts from the medical charity told the XVII International Aids Conference in Mexico that the wage-bill has blocked efforts by some countries like Rwanda to recruit qualified staff to manage the ART programme.
An estimated 70 percent of people living with HIV/AIDS who need antiretroviral therapy (ART) are still not receiving it, and MSF says the growing numbers of those who have been started on ART have only increased the burden on existing health care staff.
These workers have little time to dedicate to proper treatment and follow up of their many patients, potentially resulting in low quality of care and treatment interruption as patients become discouraged by the long waiting times for consultations.
In several countries, the shortage of qualified health staff in public-health services is linked to constraints in attracting, recruiting, and retaining health staff who are actually present in the country but are unable to join the workforce, MSF said.
This, according to the charity is because of limits on recruitment and salary in the public sector.
Rwanda, Zambia, Kenya, and Tanzania are said to have substantial numbers of unemployed clinicians and nurses in their capitals. In these countries, MSF says recruitment of extra qualified staff available on the local market would seem a rational adjunct, which could be coupled with task-shifting initiatives to achieve a stronger strategic skills mix.
The main hurdles here, according to MSF, are wage-bill restrictions or salary freezes dictated by the International Monetary Fund, Ministers of Finance, the World Bank, or health-reform strategists that “block employment of extra health staff as well as the use of international funds for salary increases in the public sector”.
Médecins Sans Frontières warns of the deadly impact that the lack of health care workers is having on AIDS treatment and care – especially in southern Africa. Experts described the scope and impact of the health care worker shortage as well as the critical need to increase government and donor commitment to taking immediate concrete steps to retain and support health care workers now.
Low salaries, poor working conditions and a lack of support and supervision are just a few of the reasons why it is growing increasingly untenable for many health care staff to stay and keep providing quality care, MSF said.
"In Thyolo district, Malawi, one nurse keeps 400 patients alive by following up their essential treatment, but her basic salary amounts to just US$3 a day," said Dr. Moses Massaquoi, MSF Malawi Medical Coordinator in a statement published in Kigali on Monday.
"It is intolerable to then be told by governments and donor countries that it is unsustainable to raise her wages, even though she is responsible for US$7,500 worth of drugs a month for her patients. Those willing to support funding for medicines must find ways to cover recurrent costs like salaries for health workers."
One successful strategy being piloted by MSF and other partners in Rwanda and other places aims to better utilize existing health care worker staff, especially in rural areas. With proper training and support, nurses and lay counsellors can reach more patients, without compromising on quality and continuity of HIV/AIDS care.
MSF data being presented at the Mexico conference shows that such targeted "task shifting" has allowed much quicker roll out of ART in Malawi, Lesotho, South Africa and Rwanda without loss of quality of care.
“Task shifting” refers to a process of delegation of tasks to health workers with lower qualifications. It may include task shifting between different groups of professional workers or from professional to lay health workers.
MSF is not convinced that this strategy can solve the wider problem.
“Task shifting, however, is no panacea to the health care worker shortage. It cannot replace concrete action to tackle the fundamental problems undermining the health workforce”, it said.