It seems there are still more questions than answers about how PEPFAR will achieve a key milestone—recruiting and retaining 140,000 new health care workers over the next five years in countries hard hit by the AIDS epidemic.
Congress included that provision when lawmakers reauthorized PEPFAR last year, part of a broader effort to strengthen developing countries’ health systems. But turning that promise into a reality is a tall order, given the severity of current workforce shortages, the time, effort and expense involved in training new doctors and nurses, and the brain drain of health care professionals from resource poor countries to more affluent ones.
During a presentation at the Global Health Council today, Karin Turner, a senior USAID official whose portfolio includes health system strengthening and heath care workforce issues for Southern Africa, said there was still some “fogginess” on how this effort would unfold in the context of PEPFAR’s pivot to focus more on health system strengthening.
Some of the uncertainties Turner highlighted:
*Will program officials and implementers be looking more at general health outcomes or HIV outcomes under the new PEPFAR law?
*What is PEPFAR II’s vision of health systems?
*Will the focus be on building sustainability or meeting new targets, or both?
Turner said there’s a lot of talk now about maintaining PEPFAR programs, rather than dramatically scaling up, and she said it’s unclear what that means. Asked if there’s been a shift in resources within PEPFAR towards health system strengthening, she said not yet.
Turner said it’s clear that more funding will be necessary to add the health systems component, but “we haven’t heard the answer yet” about whether those resources will be forthcoming.
Joining Turner at the GHC session was Saul Kornik, head of Africa Health Placements, a group that recruits doctors to work in South Africa’s severely underserved rural outposts. His group mainly brings in doctors from the U.S. and Europe, who come to work for a year or two before returning to their home countries.
While that is obviously not a sustainable model for PEPFAR, Kornik had some interesting insights to the workforce shortage problems and how best to address it. His group has found that it’s very ineffective recruit 10 doctors and put them in 10 different hospitals, because there will be no support system; they will almost certainly feel overwhelmed and leave quickly.
It’s much better, he said, to put all ten doctors (or nurses or other health workers) in the same hospital, where they can form a support network and build up morale more broadly within an institution. That, in turn, can help attract native-born physicians who see opportunities to train and be trained by other professionals, he said.
Kornik also said bad management, often even more than low pay or other problems, is a major obstacle to retention; many doctors and other health care workers in South Africa say they leave their posts because their bosses were abusive and disrespectful.
“Unless we deal with management issues, we’re not going to retain staff,” he said, noting that this was a delicate issue because many upper-level managers are political appointees.