Increase in Number of Health Workers Expands Access to HIV Services in Uganda

New increases in the number and availability of health workers are giving more people access to comprehensive HIV care in Uganda, a major step in addressing the country’s ongoing HIV epidemic and health workforce shortage.

A new article in the journal AIDS highlights the most recent results of Uganda’s investments in its health workforce, including partnering with IntraHealth International as the country worked to:

  • Deploy 7,211 newly recruited health workers to 1,030 health centers across all 111 districts of Uganda.
  • Increase the percentage of filled health worker positions by region from a mean of 55% in 2009 to 66% in 2013.
  • Develop a national electronic information system for human resources for health (iHRIS), which now tracks about 140,000 health workers and provides crucial data for decision-making.
  • Formulate potential incentive packages to address the health sector’s poor staff retention rates in rural areas, after surveying 158 health workers and 544 health professional students.

HIV prevalence in Uganda had decreased from its high of 18% in the 1990s to 6.4% in 2002. But by 2011 it had risen again to 7.3% (and higher in some regions). Part of the problem, the authors say, was a severe shortage of health workers.

In fact, a 2009 national staff audit conducted by the Ministry of Health found that 47% of established positions in government health facilities were vacant. And while 85% of Uganda’s population lives in rural areas, other data showed that about 71% of doctors and 41% of nurses and midwives were clustered in urban areas.

But Uganda’s efforts to provide greater access to health workers are paying off. They have likely contributed to the rise between 2012 and 2014 in the mean number of persons tested for HIV (a 97% increase) and in the number of people living with HIV who have started taking antiretroviral medications (a 15% increase). These increases occurred in 962 of the 1,030 Ugandan health facilities mentioned above, demonstrating an improvement in service statistics where additional health workers were deployed.

The IntraHealth-developed iHRIS software has helped Uganda’s Ministry of Health to map, track, manage, and deploy health workers where they are needed most. “With this level of evidence to inform decisions,” the authors write, “health workforce planners and managers would be better able to target recruitment, deployment, and retention efforts to the geographic areas and facilities with the highest HIV volume.” 

Health workers—in sufficient numbers and well distributed—are a key component of the global HIV response. If more countries pursue health workforce interventions such as those in Uganda, the authors say, more will move closer to achieving the ambitious 90-90-90 goal proposed by UNAIDS: that is, by 2020, that 90% of all people living with HIV will know their HIV status, 90% of all people diagnosed with HIV will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression.

IntraHealth and the Ministry of Health are now working to recruit 9,000 more health workers, which will bring the percentage of filled positions in government health facilities to 83% by 2018.

Authors of the AIDS article include IntraHealth’s Wanda Jaskiewicz, Vincent Oketcho, and Kate Tulenko. IntraHealth’s work in Uganda is funded by the US Agency for International Development and the President’s Emergency Plan for AIDS Relief.

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