In one rural district of Malawi, an AIDS-ravaged country in southern Africa, long lines of HIV-positive people stand outside medical clinics. They sometimes wait hours to grab a minute or two with a physician or nurse. Medical assistants see as many as 200 patients a day, all the while fighting doctor fatigue and burnout. “Staff shortages are vast,”  says Rachel Cohen, Médecins Sans Frontières (MSF) mission head in nearby Lesotho, another African country that faces many of the same staff problems. “Salaries are too low, working conditions are poor, and there’s a lack of proper management.”

While the developed world struggles to get meds to these regions, Cohen and her colleagues wonder—and worry about—who will dispense them. “Here in Lesotho, we have drugs available, and we have clinics that are functioning,” Cohen says. “But we have an overwhelming shortage of health care workers to actually diagnose, monitor and treat the patients.” Last May, MSF  released a sobering report, Help Wanted: Confronting the Health Care Worker Crisis to Expand Access to HIV/AIDS Treatment.  Cohen calls it a “scream out to anybody who’ll listen.”

The World Health Organization says that countries should have at least 20 doctors for every 100,000 inhabitants; the countries described in the report didn’t come anywhere close. Malawi, for example, has only 2 per 100,000, and staff numbers drop every day. Sometimes, nurses leave to take better paying jobs overseas; others lose their lives to AIDS themselves.

MSF says many international donors fear that strengthening the countries’ workforces isn’t useful because it’s not “sustainable”—meaning domestic governments will not have the capacity to eventually replace foreign assistance. The organization is working to persuade donors that such concerns are inhumane and perpetuate the crisis, requiring more and more foreign assistance. Another article penned by MSF staff recently called on the Global Fund to Fight AIDS, Tuberculosis and Malaria to put more effort into funding health worker salaries, saying that the hope for sustainability is “not realistic for low-income countries providing ART (antiretroviral therapy).” Time to phone HR.


To meet Mozambique’s national HIV treatment goals this year, it will take an additional:

130 medical doctors
125 mid-level health workers
380 nurses
200 nurse aides
90 pharmacy workers
29 lab personnel

954 health care workers total

Mozambique Ministry of Health as quoted in Help Wanted, Médicins Sans Frontières, 2007

In Botswana, health care workers often walk vast distances to visit HIV-positive patients, sometimes making only one house call a day. Last year, as an extension of its BikeTown U.S.A. program—which gives away bikes to people whom it hopes will use them to get to work or lose weight—Bicycling magazine gave 200 bikes to health workers in Botswana. The gift was part of Bristol-Myers Squibb Foundation’s Secure the Future program, which helps countries in Africa tackle the epidemic. This year, the program plans to roll out 325 bikes in Namibia and Senegal. The bikes, donated by Canadian company Kona, let the workers reach five or six patients daily. Now, if only Lance Armstrong could train them...