How labour intensive is a doctor-based delivery model for antiretroviral treatment (ART)? Evidence from an observational study in Siem Reap, Cambodia

Hdl Handle:
http://hdl.handle.net/10144/30713
Title:
How labour intensive is a doctor-based delivery model for antiretroviral treatment (ART)? Evidence from an observational study in Siem Reap, Cambodia
Authors:
Van Damme, W; Kheang, S; Janssens, B; Kober, K
Journal:
Human Resources for Health
Abstract:
BACKGROUND: Funding for scaling-up antiretroviral treatment (ART) in low-income countries has increased substantially, but the lack of human resources for health (HRH) is increasingly being identified as an important constraint for scaling-up ART. METHODS: In a clinic run by Médecins Sans Frontières in Siem Reap, Cambodia, we documented the use of doctor-time for ART in September 2004 and in August 2005, for different phases in ART (pre-ART, ART initiation, ART follow-up Year 1, & ART follow-up Year 2). Based on these observations and using a variety of assumptions for survival of patients on ART (between 90 and 95% annually) and for further reductions in doctor-time per patient (between 0 and 10% annually), we estimated the need for doctors for the period 2004 till 2013 in the Siem Reap clinic, and in a hypothetical district in sub-Saharan Africa. RESULTS: In the Siem Reap clinic, we found that from 2004 to 2005 the doctor-time needed per patient was reduced by between 14% and 33%, thanks to a reduction in number of visits per patient and shorter consultation times. In 2004, 2.06 full-time equivalent (FTE) doctors were needed for 522 patients on ART, and in 2005 this was slightly reduced to 1.97 FTE doctors for 911 patients on ART. By 2013, Siem Reap clinic will need between 2 and 5 FTE doctors for ART. In a district in sub-Saharan Africa with 200,000 inhabitants and 20% adult HIV prevalence, using a similar doctor-based ART delivery model, between 4 and 11 FTE doctors would be needed to cover 50% of ART needs. CONCLUSION: ART is labour intensive. Important reductions in doctor-time per patient can be realized during scaling-up. The doctor-based ART delivery model analysed seems adequate for Cambodia. However, for many districts in sub-Saharan Africa a doctor-based ART delivery model may be incompatible with their HRH constraints.
Affiliation:
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. Médecins Sans Frontières–Belgium, Phnom Penh, Cambodia.
Publisher:
BioMed Central
Issue Date:
1-May-2007
URI:
http://hdl.handle.net/10144/30713
DOI:
10.1186/1478-4491-5-12
PubMed ID:
17470304
Submitted date:
2008-06-13
Type:
Article
Language:
en
ISSN:
1478-4491
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorVan Damme, W-
dc.contributor.authorKheang, S-
dc.contributor.authorJanssens, B-
dc.contributor.authorKober, K-
dc.date.accessioned2008-07-01T08:44:25Z-
dc.date.available2008-07-01T08:44:25Z-
dc.date.issued2007-05-01-
dc.date.submitted2008-06-13-
dc.identifier.citationHum Resour Health 2007;5:12en
dc.identifier.issn1478-4491-
dc.identifier.pmid17470304-
dc.identifier.doi10.1186/1478-4491-5-12-
dc.identifier.urihttp://hdl.handle.net/10144/30713-
dc.description.abstractBACKGROUND: Funding for scaling-up antiretroviral treatment (ART) in low-income countries has increased substantially, but the lack of human resources for health (HRH) is increasingly being identified as an important constraint for scaling-up ART. METHODS: In a clinic run by Médecins Sans Frontières in Siem Reap, Cambodia, we documented the use of doctor-time for ART in September 2004 and in August 2005, for different phases in ART (pre-ART, ART initiation, ART follow-up Year 1, & ART follow-up Year 2). Based on these observations and using a variety of assumptions for survival of patients on ART (between 90 and 95% annually) and for further reductions in doctor-time per patient (between 0 and 10% annually), we estimated the need for doctors for the period 2004 till 2013 in the Siem Reap clinic, and in a hypothetical district in sub-Saharan Africa. RESULTS: In the Siem Reap clinic, we found that from 2004 to 2005 the doctor-time needed per patient was reduced by between 14% and 33%, thanks to a reduction in number of visits per patient and shorter consultation times. In 2004, 2.06 full-time equivalent (FTE) doctors were needed for 522 patients on ART, and in 2005 this was slightly reduced to 1.97 FTE doctors for 911 patients on ART. By 2013, Siem Reap clinic will need between 2 and 5 FTE doctors for ART. In a district in sub-Saharan Africa with 200,000 inhabitants and 20% adult HIV prevalence, using a similar doctor-based ART delivery model, between 4 and 11 FTE doctors would be needed to cover 50% of ART needs. CONCLUSION: ART is labour intensive. Important reductions in doctor-time per patient can be realized during scaling-up. The doctor-based ART delivery model analysed seems adequate for Cambodia. However, for many districts in sub-Saharan Africa a doctor-based ART delivery model may be incompatible with their HRH constraints.en
dc.language.isoenen
dc.publisherBioMed Centralen
dc.rightsArchived with thanks to Human Resources for Health Open Access policyen
dc.subject.meshAntiretroviral Therapy, Highly Activeen
dc.subject.meshCambodiaen
dc.titleHow labour intensive is a doctor-based delivery model for antiretroviral treatment (ART)? Evidence from an observational study in Siem Reap, Cambodiaen
dc.typeArticleen
dc.contributor.departmentDepartment of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. Médecins Sans Frontières–Belgium, Phnom Penh, Cambodia.en
dc.identifier.journalHuman Resources for Healthen

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