Taking the World AIDS Day challenge: on the ground in Mozambique

In 2011, the World Health Organization (WHO) announced one theme for all World AIDS Days through 2015: “Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.”

The forcefulness of this theme’s wording speaks to the public health community’s commitment to stamp out a destructive virus that kills 1.7 million people each year—not to mention eats away at quality of life, erodes communities and curbs the growth of entire regions of the world.

We at PHII are rallying by addressing one specific goal of the initiative: alleviating the massive disparity that exists in HIV treatment and testing across the world. WHO’s challenge to organizations like us is to equip every country with the capacity to care for its HIV-positive people and to make sure that testing and treatment, such as antiretroviral therapy, are accessible by all. We are joining in that mission by helping Mozambique optimize their processes around workforce development and human resources deployment in the health care system.

HIV coverage (and lack thereof) in Mozambique

In Mozambique, broad swaths of the country are left without health care infrastructure for the treatment of HIV and AIDS. An HIV-positive person living in a rural area often has to travel many miles to seek treatment. This is a daunting trek without a vehicle, and many choose not to make it at all. How do you explain a days-long absence from your community when HIV is so stigmatized that you can’t admit needing to seek treatment, or when you don’t have any family and friends farther than a half-mile away whom you could pretend to be visiting? For many others, there is no choice; jobs or family obligations may prevent the possibility of taking a few days off, and the devastating effects of untreated HIV may make a physically taxing journey out of the question.

However, all that said, some do make this trip. In fact, whole families as well as individuals walk for miles to seek HIV treatment, sometimes sleeping outdoors on the way. Once they reach their destinations, they often find themselves waiting in impossibly long queues in understaffed clinics. Others arrive to find that the clinic they were heading toward has shut down permanently—or that it’s temporarily closed because the nurse who runs the clinic alone just finished her seventh 12-hour day in a row, and she’s just too exhausted for an eighth day of the same.

With such an overwhelming number of barriers to care, many HIV-positive Mozambicans simply go without. This lack of access to care has devastating consequences: rapidly advancing infections, progressions of the disease to AIDS and increase of the spread of the infection to others.

PHII’s work toward accessible HIV treatment in Mozambique

PHII is tasked with addressing the root cause of these gaps in coverage: uneven health care worker allocation across Mozambique. We’re working closely with the Mozambique Ministry of Health, as well as the Centers for Disease Control (CDC) in Atlanta, the CDC in MozambiqueJhpiego and the Belgium Group, to improve Mozambique’s workforce planning and deployment process. This involves designing quality data-driven systems that more efficiently and systematically assign health care workers to the areas where they can do the most good.

Devan Manharlal of Jhpiego (far left) and I (second from the left) visit the Matola District’s Ministry of Health human resources department.

In January, my colleague Jim Jellison and I, accompanied by teams from our partner organizations, travelled to all regions of Mozambique, from urban to rural, to collect data and conduct interviews with human resources leaders at the national, provincial and district levels. We observed firsthand the challenges Mozambique would need to overcome, and we strove to obtain a complete picture of the unique needs of every region of the country—from the capital Maputo to the rural province of Nampula.

Since this trip, we’ve been hard at work applying PHII’s methods to develop a set of recommendations that our partners in Mozambique can use to move forward. In April, we’ll travel to Mozambique again to present our analysis to the Ministry of Health Mozambique leaders, CDC Mozambique and other implementing partners. We’ll also be presenting a digital tool that intelligently automates workforce distribution. This tool was built by a group of talented and creative students from the Georgia Institute of Technology, whom we were delighted to work with. (We’ll be jointly writing a paper with this group of forward-thinking software and industrial engineers in the near future, so stay tuned for more details on that front!)

We expect that the overall shortage of workers in the country will continue into the near future, so our recommendations focus on ensuring that each type of health care worker (e.g., a nurse, a doctor, a medical technician, etc.) will go where he or she is most needed. Over time, we hope that our recommendations will help to increase the health care worker-to-population ratio and thus decrease the overall shortage.