UNAIDS: The First 10 Years

UNAIDS The First 10 Years198government budget ceilings and available allocations, but can also (in Kenya) be traced backto an employment embargo instituted in 1993 by the Directorate of Personnel Management,largely in response to pressures of structural adjustment programmes that required largecuts in public spending 25 . So despite the desperate need for their skills, several thousandnurses are unemployed.Another reason for the shortages is the impact of AIDS on the workforce. In Zambia 26 , forexample, AIDS-related deaths account for a large percentage of nurses and doctors lost tothe country – 68% of nurses and clinical officers, compared with 23% due to resignation and9% due to retirement. Countries such as Zambia do direct public health sector employeeswho are positive to public clinics for treatment, but ‘Zambian nurses tell us that stigma makesHIV-positive staff reluctant to report for treatment at their own institutions’ 27 .Hospitals and clinics facesevere human resourcechallenges. Here inPhnom Penh, hundredsof people wait outside theCentre of Hope clinic.There are only 22 bedsfor in-patients. Lotterieshave to be drawn everymorning for any availablespace. UNAIDS/S.NooraniDonors could help by recognizing that helping to meet countries’ needs for human resourcesis ‘perhaps the single greatest contribution they could make and that demonstrating theirimpatience with the lack of capacity is counter-productive’ 28 . Often, donors are reluctant toinvest in fair salaries and benefits or training, yet these are vital to providing prevention andtreatment programmes nationwide. Donors’ reluctance often springs from a concern that byinvesting in improved salaries in one sector, they may be distorting the labour market andbe unable to sustain the necessary funding. Judges, teachers, agronomists and many otherprofessions are equally poorly paid in many countries.25ALMACO Management Consultants Ltd, in collaboration with the African Medical and Research Foundation(2005). Budget Ceiling and Health: the Kenya Case Study. Wemos Foundation, Amsterdam, October.26Feeley R, Rosen S, Fox M P, Macwan’gi M, Mazimba A (2004). The Costs of HIV/AIDS among ProfessionalStaff in the Zambian Public Health Sector. Central Board of Health, Zambia/USAID.27Ibid.28UNAIDS (2005). Making the Money Work. Where We Are and Where We Go from Here. Geneva, UNAIDS.