Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM AND Pepfar-funded HIV-activities

BACKGROUND: Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined. METHODS: A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries’ responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context. RESULTS: In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs. CONCLUSION: Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.Department of HE and Training approved lis

Perspectives psychologiques et sociologiques du travail précaire en Belgique

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Psychological and sociological perspectives on precarious employement in Belgium

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Applying the principles of AIDS 'exceptionality' to global health: challenges for global health governance

In this paper, we argue that a key feature of the “exceptionality” of the global AIDS response—its reliance on open-ended international solidarity to complement domestic efforts—can only be preserved if it is extended to broader health issues of the poorest countries of the world. This reliance on open-ended international solidarity hinges on three related principles: a new approach to sustainability, a flexible application of fiscal space constraints, and an international financing mechanism that provides long term reliable assistance. We will briefly explain these principles, focusing particularly on fiscal space constraints because the importance of that element is often overlooked or underestimated. Then we will explain why health systems and broader health issues in low-income countries need the same three principles (or similar solutions), to sustain early successes of the global AIDS response and to expand these successes. Finally, we will examine the challenges the wider application of the principles of AIDS exceptionality creates for global health governance

Universal health coverage anchored in the right to health.

This editorial was published in the Bulletin of the World Health Organization [© 2013 Bulletin of the World Health Organization] and the definite version is available at: http://www.who.int/bulletin/volumes/91/1/12-115808/en