Department of Epidemiology and Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
Hum Resour Health. 2010 Aug 11;8:19. doi: 10.1186/1478-4491-8-19.
Shortages of health workers are obstacles to utilising global health initiative (GHI) funds effectively in Africa. This paper reports and analyses two countries' health workforce responses during a period of large increases in GHI funds.
Health facility record reviews were conducted in 52 facilities in Malawi and 39 facilities in Zambia in 2006/07 and 2008; quarterly totals from the last quarter of 2005 to the first quarter of 2008 inclusive in Malawi; and annual totals for 2004 to 2007 inclusive in Zambia. Topic-guided interviews were conducted with facility and district managers in both countries, and with health workers in Malawi.
Facility data confirm significant scale-up in HIV/AIDS service delivery in both countries. In Malawi, this was supported by a large increase in lower trained cadres and only a modest increase in clinical staff numbers. Routine outpatient workload fell in urban facilities, in rural health centres and in facilities not providing antiretroviral treatment (ART), while it increased at district hospitals and in facilities providing ART. In Zambia, total staff and clinical staff numbers stagnated between 2004 and 2007. In rural areas, outpatient workload, which was higher than at urban facilities, increased further. Key informants described the effects of increased workloads in both countries and attributed staff migration from public health facilities to non-government facilities in Zambia to PEPFAR.
Malawi, which received large levels of GHI funding from only the Global Fund, managed to increase facility staff across all levels of the health system: urban, district and rural health facilities, supported by task-shifting to lower trained staff. The more complex GHI arena in Zambia, where both Global Fund and PEPFAR provided large levels of support, may have undermined a coordinated national workforce response to addressing health worker shortages, leading to a less effective response in rural areas.
卫生工作者的短缺是非洲有效利用全球卫生倡议（GHI）资金的障碍。本文报告和分析了两个国家在 GHI 资金大幅增加期间的卫生人力应对情况。
2006/07 年和 2008 年在马拉维和赞比亚的 52 个和 39 个卫生设施进行了卫生设施记录审查；马拉维包括 2005 年最后一个季度至 2008 年第一季度的季度总数；赞比亚包括 2004 年至 2007 年的年度总数。在两个国家，对设施和地区经理以及马拉维的卫生工作者进行了专题引导访谈。
设施数据证实，两国的艾滋病毒/艾滋病服务提供都有了显著扩大。在马拉维，这得到了大量低级别人员的增加和临床工作人员人数略有增加的支持。在城市设施、农村卫生中心和未提供抗逆转录病毒治疗（ART）的设施中，常规门诊工作量下降，而在地区医院和提供 ART 的设施中则增加。在赞比亚，2004 年至 2007 年期间，总工作人员和临床工作人员人数停滞不前。在农村地区，门诊工作量高于城市设施，进一步增加。主要信息提供者描述了两国工作量增加的影响，并将赞比亚公共卫生设施向非政府设施的工作人员迁移归因于 PEPFAR。
马拉维仅从全球基金获得大量 GHI 资金，设法增加了整个卫生系统各级的设施工作人员：城市、地区和农村卫生设施，得到向低级别工作人员转移任务的支持。在更为复杂的 GHI 领域，全球基金和 PEPFAR 都提供了大量支持，这可能破坏了协调国家应对卫生工作者短缺的劳动力应对措施，导致农村地区的应对效果较差。
