This paper from the World Health Organization (WHO) aims to assess the human resources impact of Malawi’s rapidly growing antiretroviral therapy (ART) programme and balance this against the survival benefit of health-care workers who have accessed ART themselves. The study uses a national cross-sectional survey of the human resource allocation in all public-sector health facilities providing ART in mid-2006 and includes a survival analysis of health-care workers who have accessed ART in public and private facilities.

The report finds that:
• 59,581 patients have accessed ART from 95 public and 28 private facilities
• the public sites provided ART services on 2.4 days per week on average, requiring 7 per cent of the clinician workforce, 3 per cent of the nursing workforce and 24 per cent of the ward clerk workforce available at the facilities
• the researchers identified 1024 health-care workers in the national ART-patient cohort (2 per cent of all ART patients)
• the probabilities for survival on ART at 6 months, 12 months and 18 months were 85 per cent, 81 per cent and 78 per cent, respectively
• an estimated 250 health-care workers’ lives were saved 12 months after ART initiation. Their combined work-time of more than 1000 staff-days per week was equivalent to the human resources required to provide ART at the national level

The authors conclude that a large number of ART patients in Malawi are managed by a small proportion of the health-care workforce. Many health-care workers have accessed ART with good treatment outcomes. Currently, staffing required for ART balances against health-care workers’ lives saved through treatment, although this may change in the future.