Reproductive Health Matters
Volume 14, Issue 27 , Pages 12-23 , May 2006

Health Systems and Access to Antiretroviral Drugs for HIV in Southern Africa: Service Delivery and Human Resources Challenges

  • Helen Schneider

      Affiliations

    • Associate Professor, Centre for Health Policy, University of Witwatersrand, Johannesburg, South Africa
  • ,
  • Duane Blaauw

      Affiliations

    • Senior Researcher, Centre for Health Policy, University of Witwatersrand
  • ,
  • Lucy Gilson

      Affiliations

    • Associate Professor, Centre for Health Policy, University of Witwatersrand, and Reader, Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK
  • ,
  • Nzapfurundi Chabikuli

      Affiliations

    • Senior Researcher, Centre for Health Policy, University of Witwatersrand
  • ,
  • Jane Goudge

      Affiliations

    • Senior Researcher, Centre for Health Policy, University of Witwatersrand

References 

  1. Farmer P, Leandre F, Mukherjee J, et al. Community-based treatment of advanced HIV disease: introducing DOT–HAART (directly observed therapy with highly active antiretroviral therapy). Bulletin of World Health Organization. 2001;79(12):1145–1151
  2. Kasper T, Coetzee D, Louis F, et al. Demystifying antiretroviral therapy in resource-poor settings. Essential Drugs Monitor. 2003;32:20–21
  3. Joint Learning Initiative. Human Resources for Health and Development: A Joint Learning Initiative. New York: Rockefeller Foundation; 2003;
  4. Nunn P, Harries A, Godfrey-Fausset P, et al. The research agenda for improving health policy, systems performance and service delivery for tuberculosis control: a WHO perspective. Bulletin of World Health Organization. 2002;80:471–476
  5. Bryce J, el Arifeen S, Pariyo G, et al. Multi-country evaluation of IMCI Study Group. Reducing child mortality: can public health deliver?. Lancet. 2003;362:159–164
  6. Lush L, Cleland J, Walt G, et al. Integrating reproductive health: myth and ideology. Bulletin of World Health Organization. 1999;77:771–777
  7. Wemos Foundation. Good intentions with side-effects: Information on Global Public-Private Initiatives in Health. Amsterdam: Wemos Foundation; 2004;
  8. McCoy D, Chopra M, Loewenson R, et al. Expanding access to antiretroviral therapy in sub-Saharan Africa: avoiding the pitfalls and dangers; capitalizing on opportunities. American Journal of Public Health. 2005;95(1):18–22
  9. Saunders DM, Chopra M. Confronting Africa's health crisis: more of the same will not be enough [Education and Debate]. BMJ. 2005;331:755–758
  10. Loewenson R, McCoy D. Access to antiretroviral treatment in Africa [Editorial]. BMJ. 2004;328:241–242
  11. World Health Organization. Health and the Millennium Development Goals. Geneva: WHO; 2005;
  12. Hanson K, Ranson KM, Oliveira-Cruz V, et al. Expanding access to priority health interventions: a framework for understanding constraints to scaling up. Journal of International Development. 2003;15:1–14
  13. World Health Organization. The World Health Report 2000. Health Systems: Improving Performance. Geneva: WHO; 2000;
  14. Rosen S, Sanne I, Collier A, et al. Rationing antiretroviral therapy for HIV/AIDS in Africa: choices and consequences (Policy Forum). Public Library of Science Medicine. 2005;2(11):e303;At: < http://medicine.plosjournals.org>
  15. Cassels A. A Guide to Sector-Wide Approaches for Health Development: Concepts, Issues and Working Arrangements. Geneva: World Health Organization; 1997;
  16. Singh N, Berman SM, Swindells S, et al. Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy. Clinical Infectious Diseases. 1999;29(4):824–830
  17. Coetzee D, Hildebrand K, Boulle A, et al. Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa. AIDS. 2004;18:887–895
  18. Coetzee D, Boulle A, Hildebrand K, et al. Promoting adherence to antiretroviral therapy: the experience from a primary care setting in Khayelitsha, South Africa. AIDS. 2004;18(Suppl.3):S27–S31
  19. MASA Antiretroviral Therapy. Access for All: The Masa Programme – providing all Batswana with access to care and treatment. Vol.9, June/July 2004.
  20. Médecins sans Frontières. Antiretroviral Therapy in Primary Health Care: Experience of the Chiradzulu Programme in Malawi Case Study. Briefing Document. Malawi: MSF; 2004;
  21. Kemp J, Aitken JM, Le Grand S, et al. Equity in health sector responses to HIV/AIDS in Malawi. Discussion Paper 5. Harare: Equinet; 2003;
  22. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, part 2. Journal of the American Medical Association. 2002;288:1909–1914
  23. Blaauw D, Gilson L, Penn-Kekana L, et al. Organisational relationships and the “software” of health sector reform. Background paper. Disease Control Priorities Project. 2003;At: < www.fic.nih.gov/dcpp/>
  24. Hongoro C, McPake B. Human resources in health: putting the right agenda back to front [Editorial]. Tropical Medicine and International Health. 2003;8:965–966
  25. Liese B, Blanchet N, Dussault G. The Human Resource Crisis in Health Services in Sub-Saharan Africa. Background paper. Washington DC: World Bank; 2003;
  26. Kober K, van Damme W. Scaling up access to antiretroviral treatment in southern Africa: who will do the job?. Lancet. 2004;364(9428):103–107
  27. Chen L. Hanvoravongchai. HIV/AIDS and human resources [Editorial]. Bulletin of World Health Organization. 2005;83(4):243–244
  28. Chen L, Evans T, Anand S, et al. Human resources for health: overcoming the crisis. Lancet. 2004;364:1984–1990
  29. USAID. The Health Sector Human Resource Crisis in Africa: An Issues Paper. Washington DC: USAID, AED, SARA; 2003;
  30. Kurowski C, Wyss K, Abdulla S, et al. Human resources for health: requirements and availability in the context of scaling-up priority interventions in low-income countries. Case studies from Tanzania and Chad. Report to the Department for International Development. London: LSHTM, IDRC, STI; 2004;
  31. South African Department of Health. Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa. Pretoria: Department of Health; November 2003;
  32. Padarath A, Ntuli A, Burthiaume L. Human resources. In:  Ijumab PI,  Day C,  Ntuli A editor. South African Health Review 2003-04. Durban: Health Systems Trust; 2004;
  33. Marchal B, Kegels G. Health workforce imbalance in terms of globalization: brain drain or professional mobility. International Journal of Health Planning and Management. 2003;18(Suppl.1):S89–S101
  34. Stilwell B, Diallo K, Zurn P, et al. Developing evidence-based ethical policies on the migration of health workers: conceptual and practical challenges. Human Resources for Health. 2003;1(1):8;At: < http://www.human-resources-health.com/>
  35. Padarath A, Chamberlain C, McCoy D, et al. Health personnel in southern Africa: confronting maldistribution and brain drain. Equinet Discussion Paper No.3. Zimbabwe: Equinet, Health Systems Trust, MEDACT, (undated).
  36. Dovlo D. Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review. Human Resources for Health. 2004;2:7;At: < http://www.human-resources-health.com/>
  37. Friedman I. CHWs and Community Care-givers: Towards a Unified Model of Practice. In:  Ijumba P,  Barron P editor. South African Health Review 2005. Durban: Health Systems Trust; 2005;
  38. Tawfik L, Kinoti S. The Impact of HIV/AIDS on the Health Sector in Sub-Saharan Africa: the Issue of Human Resources. Washington DC: SARA, AED, USAID; 2002;
  39. Shisana O, Hall E, Maluleke KR, et al. The Impact of HIV/AIDS on the Health Sector: National Survey of Health Personnel, Ambulatory and Hospitalised Patients and Health Facilities, 2002. Pretoria: Human Sciences Research Council, Medical University of South Africa, Medical Research Council; 2002;
  40. McPake B, Asiimwe D, Mwesigye F, et al. Informal economic activities of public health workers in Uganda: implications for quality and accessibility. Social Science and Medicine. 1999;49:849–865
  41. Franco LM, Bennett S, Kanfer R. Health sector reform and public sector health worker motivation: a conceptual framework. Social Science and Medicine. 2002;54:1255–1266
  42. Mackintosh M, Tibandebage P. Sustainable redistribution with health care markets? Rethinking regulatory intervention in the Tanzanian context. Discussion Papers in Economics No.23. Milton Keynes: Open University; 2000;
  43. Van Lerberghe W, Conceiçao C, Van Damme W, Ferrinho P. When staff is underpaid: dealing with the individual coping strategies of health personnel. Bulletin of World Health Organization. 2002;80(7):581–584
  44. Segall M. District health systems in a neoliberal world: a review of five key policy areas. International Journal of Health Planning and Management. 2003;18(Suppl.1):S5–S26
  45. Gilson L, Palmer N, Schneider H. Trust and health worker performance: exploring a conceptual framework using South African evidence. Social Science and Medicine. 2005;61:1418–1429
  46. Travis P, Egger D, Davies P, et al. Towards Better Stewardship: Concepts and Critical Issues. In:  Murray CJL,  Evans DB editor. Health Systems Performance Assessment Debates, Methods and Empiricism. Geneva: WHO; 2003;

PII: S0968-8080(06)27232-X

doi: 10.1016/S0968-8080(06)27232-X

Reproductive Health Matters
Volume 14, Issue 27 , Pages 12-23 , May 2006