Strengthening HR Capacity to Address the HIV Crisis Dr. Mphu Ramatlapeng Minister of Health, Lesotho 2 February 2012 Father Michael Kelly Lecture

Presentation Outline Overview of HRH in the Developing World Lesotho’s Case o Country Overview o HRH Status o Interventions o Results o Looking Forward

In the developing world, especially Africa, health worker to population ratios are much lower than in the developed world Number of Health Workers (Doctors, Nurses, Midwives) Per 1,000 People By Region Source: Conway M.D. et al, “Addressing Africa’s health workforce crisis,” McKinsey Quarterly, November 2007 World Health Organization’s recommended minimum ratio of 2.5 health workers per 1,000 people

Africa, more than any other region, bears a disproportionate percentage of disease burden relative to its health workforce % of Global Workforce Distribution of Health Workers By Level of Health Expenditure and Disease Burden Source: World Health Organization. World health report 2006: working together for health. Geneva: WHO; Health workers are distributed unevenly - Africa suffers more than 24% of the global burden of disease but has access to only 3% of health workers Note: Size of dots represent health expenditure % of Global Burden of Disease

The Kingdom of Lesotho is a landlocked country within South Africa characterized by mountainous terrain Population of ~2 million 10 districts; 30,355 sq km 1/3 of land is lowlands; 2/3 are foothills and mountainous regions Sesotho and English spoken Parliamentary Constitutional Monarchy Domestic economy comprises manufacturing (e.g. textiles), diamonds, agriculture Lesotho At a Glance

Lesotho’s HIV burden is among the highest in the world HIV/AIDS Statistics HIV Prevalence23.1% People Living with HIV/AIDS 290, ,000 adults -37,000 children People Needing ART 138, ,000 adults -23,000 children People On ART 84, ,331 adults -5,643 children HIV+ Pregnant Women Per Year ~15,200 PMTCT Coverage81% Source: 2011 Lesotho MOHSW Annual Joint Review 3 rd highest HIV prevalence in the world Maternal mortality rate: o 1,155 per 100,000 live births Infant mortality rate: o 91 per 1,000 live births

Lesotho faces a shortage of nurses that contributes to the prevention of achievement of health related MDGs Source: 2011 Nursing Education Partnership Initiative (NEPI) MOHSW Lesotho Assessment Projected Versus Target Nurse Numbers Number of Nurses Nursing/midwifery targets set using WHO recommended minimum threshold (1.73 nurses/midwives per 1000 people) to achieve MDGs Target Numbers Projected Numbers

Lesotho introduced several interventions with the support of key partners, including Irish Aid Nursing Initiative Mentoring: Clinical and Laboratory Access to Medicines Rural Initiative Support for 150 nurses enabled de-centralization of health care services Early adopter of task-shifting ART initiation to nurses Mentoring enabled built capacity to provide high quality services Clinical: Over 600 healthcare workers have received mentoring Lab: Mentorship enabled first SLMTA (Strengthening Laboratory Management Towards Accreditation) graduates in Africa Supply chain management support enabled HR to provide HIV care and treatment Lesotho Flying Doctors Services clinics serve a population of ~100,000 Over 5,500 patients enrolled on ART since inception of program Irish Aid Contribution: €16.4m

Over time, health centers in the most rural areas of Lesotho have experienced dramatic improvements in service offerings Over a hundred thousand people use these clinics as their primary source of health care ~50,000 people have accessed HIV testing and counselling services at the seven centres with Partners In Health support 5,500+ patients have been enrolled on ART at the seven centres with Partners In Health support In many cases patients travel for over two days to access health services at these clinics Data as per end of 2010, the last year from which data is currently available

Additionally, the numbers of adults and children on ART have consistently increased, in part due to strengthened HR Source: Lesotho MOHSW Annual Joint Review Data Adults on ARTChildren on ART

Moving forward, a number of initiatives are planned to further strengthen HR capacity in Lesotho Nursing Education Partnership Initiative (NEPI) Medical School Supports creation and sustainability of quality, innovative nursing education models Supports finite bundle of interventions in individual nursing schools 40 Basotho students currently studying in Zimbabwe Students will return to Lesotho to finish three years of training at newly constructed training facility

Questions? Thank You!