SidaSubSaharaV1, PascalFrancis, Curation, bibRecord, 000429

Scaling-up antiretroviral treatment in Southern African countries with human resource shortage : How will health systems adapt?

Identifieur interne : 000429 ( PascalFrancis/Curation ); précédent : 000428; suivant : 000430

Scaling-up antiretroviral treatment in Southern African countries with human resource shortage : How will health systems adapt?

Auteurs : Wim Van Damme [Belgique] ; Katharina Kober [Belgique] ; Guy Kegels [Belgique]

Source :

Social science & medicine : (1982) [ 0277-9536 ] ; 2008.

RBID : Pascal:08-0283880

Descripteurs français

Pascal (Inist)
- Innovation, Chimiothérapie, Sud, Africain, Pays, Ressources humaines, Pénurie, Accessibilité, Système santé, SIDA, Virus immunodéficience humaine, Antiviral, Santé publique, Soin, Afrique subsaharienne, Médecine sociale, Homme.
Wicri :
- topic : Innovation, Pénurie, Santé publique, Médecine sociale, Homme.

English descriptors

KwdEn :
- AIDS, Accessibility, African, Antiviral, Care, Chemotherapy, Countries, Health system, Human, Human capital, Human immunodeficiency virus, Innovation, Public health, Shortage, Social medicine, South, Sub-Saharan Africa.

Abstract

Scaling-up antiretroviral treatment (ART) to socially meaningful levels in low-income countries with a high AIDS burden is constrained by (1) the continuously growing caseload of people to be maintained on long-term ART; (2) evident problems of shortage and skewed distribution in the health workforce; and (3) the heavy workload inherent to presently used ART delivery models. If we want to imagine how health systems can react to such challenges, we need to understand better what needs to be done regarding the different types of functions ART requires, and how these can be distributed through the care supply system, knowing that different functions rely on different rationales (professional, bureaucratic, social) for which the human input need not necessarily be found in formal healthcare supply systems. Given the present realities of an increasingly pluralistic healthcare supply and highly eclectic demand, we advance three main generic requirements for ART interventions to be successful: trustworthiness, affordability and exclusiveness - and their constituting elements. We then apply this analytic model to the baseline situation (no fundamental changes) and different scenarios. In Scenario A there are no fundamental changes, but ART gets priority status and increased resources. In Scenario B the ART scale-up strengthens the overall health system: we detail a B technocratic variant scenario, with profoundly re-engineered ART service production, including significant task shifting, away from classical delivery models and aimed at maximum standardisation and control of all operations; while in the B2 community-based variant scenario the typology of ART functions is maximally exploited to distribute the tasks over a human potential pool that is as wide as possible, including patients and possible communities. The latter two scenarios would entail a high degree of de-medicalisation of ART.

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Le document en format XML

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<front><div type="abstract" xml:lang="en">Scaling-up antiretroviral treatment (ART) to socially meaningful levels in low-income countries with a high AIDS burden is constrained by (1) the continuously growing caseload of people to be maintained on long-term ART; (2) evident problems of shortage and skewed distribution in the health workforce; and (3) the heavy workload inherent to presently used ART delivery models. If we want to imagine how health systems can react to such challenges, we need to understand better what needs to be done regarding the different types of functions ART requires, and how these can be distributed through the care supply system, knowing that different functions rely on different rationales (professional, bureaucratic, social) for which the human input need not necessarily be found in formal healthcare supply systems. Given the present realities of an increasingly pluralistic healthcare supply and highly eclectic demand, we advance three main generic requirements for ART interventions to be successful: trustworthiness, affordability and exclusiveness - and their constituting elements. We then apply this analytic model to the baseline situation (no fundamental changes) and different scenarios. In Scenario A there are no fundamental changes, but ART gets priority status and increased resources. In Scenario B the ART scale-up strengthens the overall health system: we detail a B technocratic variant scenario, with profoundly re-engineered ART service production, including significant task shifting, away from classical delivery models and aimed at maximum standardisation and control of all operations; while in the B2 community-based variant scenario the typology of ART functions is maximally exploited to distribute the tasks over a human potential pool that is as wide as possible, including patients and possible communities. The latter two scenarios would entail a high degree of de-medicalisation of ART.</div>
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<fC01 i1="01" l="ENG"><s0>Scaling-up antiretroviral treatment (ART) to socially meaningful levels in low-income countries with a high AIDS burden is constrained by (1) the continuously growing caseload of people to be maintained on long-term ART; (2) evident problems of shortage and skewed distribution in the health workforce; and (3) the heavy workload inherent to presently used ART delivery models. If we want to imagine how health systems can react to such challenges, we need to understand better what needs to be done regarding the different types of functions ART requires, and how these can be distributed through the care supply system, knowing that different functions rely on different rationales (professional, bureaucratic, social) for which the human input need not necessarily be found in formal healthcare supply systems. Given the present realities of an increasingly pluralistic healthcare supply and highly eclectic demand, we advance three main generic requirements for ART interventions to be successful: trustworthiness, affordability and exclusiveness - and their constituting elements. We then apply this analytic model to the baseline situation (no fundamental changes) and different scenarios. In Scenario A there are no fundamental changes, but ART gets priority status and increased resources. In Scenario B the ART scale-up strengthens the overall health system: we detail a B technocratic variant scenario, with profoundly re-engineered ART service production, including significant task shifting, away from classical delivery models and aimed at maximum standardisation and control of all operations; while in the B2 community-based variant scenario the typology of ART functions is maximally exploited to distribute the tasks over a human potential pool that is as wide as possible, including patients and possible communities. The latter two scenarios would entail a high degree of de-medicalisation of ART.</s0>
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<fC03 i1="02" i2="X" l="FRE"><s0>Chimiothérapie</s0>
<s5>03</s5>
</fC03>
<fC03 i1="02" i2="X" l="ENG"><s0>Chemotherapy</s0>
<s5>03</s5>
</fC03>
<fC03 i1="02" i2="X" l="SPA"><s0>Quimioterapia</s0>
<s5>03</s5>
</fC03>
<fC03 i1="03" i2="X" l="FRE"><s0>Sud</s0>
<s5>05</s5>
</fC03>
<fC03 i1="03" i2="X" l="ENG"><s0>South</s0>
<s5>05</s5>
</fC03>
<fC03 i1="03" i2="X" l="SPA"><s0>Sur</s0>
<s5>05</s5>
</fC03>
<fC03 i1="04" i2="X" l="FRE"><s0>Africain</s0>
<s5>06</s5>
</fC03>
<fC03 i1="04" i2="X" l="ENG"><s0>African</s0>
<s5>06</s5>
</fC03>
<fC03 i1="04" i2="X" l="SPA"><s0>Africano</s0>
<s5>06</s5>
</fC03>
<fC03 i1="05" i2="X" l="FRE"><s0>Pays</s0>
<s5>08</s5>
</fC03>
<fC03 i1="05" i2="X" l="ENG"><s0>Countries</s0>
<s5>08</s5>
</fC03>
<fC03 i1="05" i2="X" l="SPA"><s0>País</s0>
<s5>08</s5>
</fC03>
<fC03 i1="06" i2="X" l="FRE"><s0>Ressources humaines</s0>
<s5>09</s5>
</fC03>
<fC03 i1="06" i2="X" l="ENG"><s0>Human capital</s0>
<s5>09</s5>
</fC03>
<fC03 i1="06" i2="X" l="SPA"><s0>Capital humano</s0>
<s5>09</s5>
</fC03>
<fC03 i1="07" i2="X" l="FRE"><s0>Pénurie</s0>
<s5>11</s5>
</fC03>
<fC03 i1="07" i2="X" l="ENG"><s0>Shortage</s0>
<s5>11</s5>
</fC03>
<fC03 i1="07" i2="X" l="SPA"><s0>Penuria</s0>
<s5>11</s5>
</fC03>
<fC03 i1="08" i2="X" l="FRE"><s0>Accessibilité</s0>
<s5>12</s5>
</fC03>
<fC03 i1="08" i2="X" l="ENG"><s0>Accessibility</s0>
<s5>12</s5>
</fC03>
<fC03 i1="08" i2="X" l="SPA"><s0>Accesibilidad</s0>
<s5>12</s5>
</fC03>
<fC03 i1="09" i2="X" l="FRE"><s0>Système santé</s0>
<s5>17</s5>
</fC03>
<fC03 i1="09" i2="X" l="ENG"><s0>Health system</s0>
<s5>17</s5>
</fC03>
<fC03 i1="09" i2="X" l="SPA"><s0>Sistema salud</s0>
<s5>17</s5>
</fC03>
<fC03 i1="10" i2="X" l="FRE"><s0>SIDA</s0>
<s5>18</s5>
</fC03>
<fC03 i1="10" i2="X" l="ENG"><s0>AIDS</s0>
<s5>18</s5>
</fC03>
<fC03 i1="10" i2="X" l="SPA"><s0>SIDA</s0>
<s5>18</s5>
</fC03>
<fC03 i1="11" i2="X" l="FRE"><s0>Virus immunodéficience humaine</s0>
<s2>NW</s2>
<s5>19</s5>
</fC03>
<fC03 i1="11" i2="X" l="ENG"><s0>Human immunodeficiency virus</s0>
<s2>NW</s2>
<s5>19</s5>
</fC03>
<fC03 i1="11" i2="X" l="SPA"><s0>Human immunodeficiency virus</s0>
<s2>NW</s2>
<s5>19</s5>
</fC03>
<fC03 i1="12" i2="X" l="FRE"><s0>Antiviral</s0>
<s5>20</s5>
</fC03>
<fC03 i1="12" i2="X" l="ENG"><s0>Antiviral</s0>
<s5>20</s5>
</fC03>
<fC03 i1="12" i2="X" l="SPA"><s0>Antiviral</s0>
<s5>20</s5>
</fC03>
<fC03 i1="13" i2="X" l="FRE"><s0>Santé publique</s0>
<s5>21</s5>
</fC03>
<fC03 i1="13" i2="X" l="ENG"><s0>Public health</s0>
<s5>21</s5>
</fC03>
<fC03 i1="13" i2="X" l="SPA"><s0>Salud pública</s0>
<s5>21</s5>
</fC03>
<fC03 i1="14" i2="X" l="FRE"><s0>Soin</s0>
<s5>22</s5>
</fC03>
<fC03 i1="14" i2="X" l="ENG"><s0>Care</s0>
<s5>22</s5>
</fC03>
<fC03 i1="14" i2="X" l="SPA"><s0>Cuidado</s0>
<s5>22</s5>
</fC03>
<fC03 i1="15" i2="X" l="FRE"><s0>Afrique subsaharienne</s0>
<s2>NG</s2>
<s5>23</s5>
</fC03>
<fC03 i1="15" i2="X" l="ENG"><s0>Sub-Saharan Africa</s0>
<s2>NG</s2>
<s5>23</s5>
</fC03>
<fC03 i1="15" i2="X" l="SPA"><s0>Africa subsahariana</s0>
<s2>NG</s2>
<s5>23</s5>
</fC03>
<fC03 i1="16" i2="X" l="FRE"><s0>Médecine sociale</s0>
<s5>25</s5>
</fC03>
<fC03 i1="16" i2="X" l="ENG"><s0>Social medicine</s0>
<s5>25</s5>
</fC03>
<fC03 i1="16" i2="X" l="SPA"><s0>Medicina social</s0>
<s5>25</s5>
</fC03>
<fC03 i1="17" i2="X" l="FRE"><s0>Homme</s0>
<s5>26</s5>
</fC03>
<fC03 i1="17" i2="X" l="ENG"><s0>Human</s0>
<s5>26</s5>
</fC03>
<fC03 i1="17" i2="X" l="SPA"><s0>Hombre</s0>
<s5>26</s5>
</fC03>
<fC07 i1="01" i2="X" l="FRE"><s0>Traitement</s0>
</fC07>
<fC07 i1="01" i2="X" l="ENG"><s0>Treatment</s0>
</fC07>
<fC07 i1="01" i2="X" l="SPA"><s0>Tratamiento</s0>
</fC07>
<fC07 i1="02" i2="X" l="FRE"><s0>Virose</s0>
</fC07>
<fC07 i1="02" i2="X" l="ENG"><s0>Viral disease</s0>
</fC07>
<fC07 i1="02" i2="X" l="SPA"><s0>Virosis</s0>
</fC07>
<fC07 i1="03" i2="X" l="FRE"><s0>Infection</s0>
</fC07>
<fC07 i1="03" i2="X" l="ENG"><s0>Infection</s0>
</fC07>
<fC07 i1="03" i2="X" l="SPA"><s0>Infección</s0>
</fC07>
<fC07 i1="04" i2="X" l="FRE"><s0>Lentivirus</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="04" i2="X" l="ENG"><s0>Lentivirus</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="04" i2="X" l="SPA"><s0>Lentivirus</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="05" i2="X" l="FRE"><s0>Retroviridae</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="05" i2="X" l="ENG"><s0>Retroviridae</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="05" i2="X" l="SPA"><s0>Retroviridae</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="06" i2="X" l="FRE"><s0>Virus</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="06" i2="X" l="ENG"><s0>Virus</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="06" i2="X" l="SPA"><s0>Virus</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="07" i2="X" l="FRE"><s0>Afrique</s0>
<s2>NG</s2>
</fC07>
<fC07 i1="07" i2="X" l="ENG"><s0>Africa</s0>
<s2>NG</s2>
</fC07>
<fC07 i1="07" i2="X" l="SPA"><s0>Africa</s0>
<s2>NG</s2>
</fC07>
<fC07 i1="08" i2="X" l="FRE"><s0>Immunodéficit</s0>
<s5>37</s5>
</fC07>
<fC07 i1="08" i2="X" l="ENG"><s0>Immune deficiency</s0>
<s5>37</s5>
</fC07>
<fC07 i1="08" i2="X" l="SPA"><s0>Inmunodeficiencia</s0>
<s5>37</s5>
</fC07>
<fC07 i1="09" i2="X" l="FRE"><s0>Immunopathologie</s0>
<s5>39</s5>
</fC07>
<fC07 i1="09" i2="X" l="ENG"><s0>Immunopathology</s0>
<s5>39</s5>
</fC07>
<fC07 i1="09" i2="X" l="SPA"><s0>Inmunopatología</s0>
<s5>39</s5>
</fC07>
<fN21><s1>182</s1>
</fN21>
<fN44 i1="01"><s1>OTO</s1>
</fN44>
<fN82><s1>OTO</s1>
</fN82>
</pA>
</standard>
</inist>
</record>

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	Le SIDA en Afrique subsaharienne (serveur d'exploration)
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Le SIDA en Afrique subsaharienne (serveur d'exploration)

Scaling-up antiretroviral treatment in Southern African countries with human resource shortage : How will health systems adapt?

Scaling-up antiretroviral treatment in Southern African countries with human resource shortage : How will health systems adapt?

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