The gender dimension
Another important issue in discussing the HRH cris
is in the context of HIV/AIDS is the gender
dimension. One of the MDGs is to promote gender equality and empower women. In fact, more
women than men are affected by the epidemic direct
ly, and indirectly as caregivers.
The attrition rate
of front-line workers in the health sector is exa
cerbated by HIV/AIDS beca
use more women than men
serve at the operational level, women are leaving clinical nursing services, and more women than men
are dying of AIDS due to increased disease risk.
Front-line health workers in sub-Saharan Africa are
largely female at the operational level, while top
management and policy levels have been mainly male. In Ghana in the late 1990s, 59% of all public
health staff was female, but this reduced to 33.5%
at the Ministry of Health headquarters. Only 17%
of doctors were female as compared to 87.4% of registered nurses and 90.2% of enrolled nurses (
13
).
In Malawi in 2003, 75% of service providers le
aving clinical service provision were women (
14
). A
disproportionate risk of HIV infection has been
linked to male/female power differentials (
15
) to
wage differentials, to nurses’ subordination to physicians (
16
) and to the undervaluing of caring
labour in the formal economy (
17
). Policies must respond to gender-related impacts.
Health system effects of HIV/AIDS
HIVAIDS has changed the landscape of disease in the
developing world, especially in Africa, due to
the resurgence of common conditions and therefore increased demand for preventive and curative
services to respond to the epidemiological and clinic
al impacts of the pandemi
c. These effects include
increased burden of disease, increas
ed service needs associated with
caring for these illnesses and for
HIV/AIDS itself, and the inadequate and diminishing capacity to respond to these needs, central to
which is the limited human resource capacity.
The
increased disease burden
due to increased cases of illnesses
such TB, malnutrition, diarrhoea,
meningitis, pneumocystis carinii pneumonia (PCP) in
the form of opportunistic infections associated
with HIV infection means that prevention and care
and treatment programmes must be modified to
respond to the new scenarios. Public health special
ists, clinicians, pathologists, counselors and various
others cannot use the traditional skills to deal with
the changing epidemiology and clinical dimensions
of the epidemic. In Malawi, over the last two deca
des TB case notification rates have increased five-
fold, and the reported cases per 100 000 population have risen from 95 in 1987 to 275 in 2001 (
18
). In
Swaziland, for example, the rate of TB, per 100 000 population increased by almost four times from
around 210 in 1990 to 820 in 2004. (It is widely accep
ted that HIV/AIDS drives the incidence of TB.)
As suggested by Figure 4, “Reported TB patients, Swaziland, 1991–2004”, the increase in TB rates
has had a marked effect on hospitals and staff responsibilities, despite increasing emphasis on
ambulatory and home-based care for TB. Although the
average length of stay for TB has fallen due to
a policy change, the length of stay for TB remains
around 14 days, the highest of all major diagnoses
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