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The costs of HIV/AIDS among professional staff in the Zambian public health sector

Central Board of Health

September 2004

Research Team: Rich Feeley (principal investigator), Sydney Rosen, Matthew Fox, Mubiana Macwan'gi, Arthur Mazimba

SARPN acknowledges the Development Experience Clearinghouse website as the source of this report:
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Executive Summary

Despite their high level of training and medical knowledge, health professionals remain a population that is vulnerable to HIV/AIDS. AIDS-related mortality has been recognized as a significant factor in the loss of trained health staff in high prevalence countries, but little empirical research has been done to quantify the damage. In this study, we applied a case/comparison methodology to estimate the costs of HIV infection in the professional workforce at three Zambian healthcare institutions: Lusaka District Health Management Team, University Teaching Hospital (the national tertiary care hospital) and Kasama District Hospital and Health Management Team. Deaths or medical retirements among professional staff were analyzed wherever the complete personnel records were available, with the exclusion of cases resulting from violence, accident or disease of sudden onset. 108 cases were identified over a three-year period ending in October 2003. Each case was matched with two comparisons of similar age, sex and professional training. Data were collected for both cases and comparisons on absenteeism, compensation and medical care and reimbursement. Data were also collected on death and retirement benefits paid, or owed, to the cases.

Between November 2002 to October 2003, death rates were 0.4 percent for doctors, 2.8 percent for clinical officers and 3.5 percent for nurses working at the study sites. Because some records were missing, we could not determine the exact proportion of deaths due to AIDS or related chronic diseases. In the final year of employment, those who left the workforce because of illness recorded an average of 28 additional days of leave. Costs associated with this additional leave, plus death or retirement related payments averaged $4,056 for a doctor, $2,678 for a clinical officer and $3,674 for a nurse.

Although we collected data on hospital admissions and medical reimbursements, no information was obtained on many of the cases, suggesting that such records are incomplete, or that individuals choose to be treated away from their normal place of employment. The records confirmed an increase in the utilization of health care by those who died, and we have added an allowance of $200 for the incremental health costs associated with AIDS. Total costs were approximately 3.6 percent of the current payroll for these classes of professionals in these institutions.

We were we not able to quantify overtime payments or loss of the productivity as a result of absenteeism and illness. In addition, there is undoubtedly some HIV/AIDS related absenteeism included in the comparisons. For these reasons, our results underestimate the total cost of HIV in healthcare workers.

Perhaps the most disturbing finding is the cumulative impact that these death rates have on trained health cadres. For doctors, mortality is not the largest reason for attrition from the work force, nor the most important factor contributing to the high-observed vacancy rates. But for clinical officers and nurses, death is the largest single reason for loss. The average age at death for all health professionals was 37.7 years. Clinical officers die with 57 percent of their normal career remaining; nurses die halfway through the normal career. The current output of clinical officers would have to increase by 80 percent to offset observed AIDS mortality. Graduating classes of nurses would have to expand by a 50 percent to offset current mortality.

HIV prevention, though essential, will not reduce the number of existing infections in health professionals. Expanding the output of training classes is a longer-term solution; it will be several years before higher training quotas can offset increasing vacancy rates. In the short- to medium-term, the most effective way to reduce attrition and vacancies among nurses and clinical officers is through the effective treatment of AIDS. If effective antiretroviral treatment is provided, it should be possible to increase the productive life span of HIV positive professionals by five years or more. If such treatment costs $500 per person per year, the costs (that we have been able to document) incurred with each death will purchase six to eight years of antiretroviral therapy. If all professionals who need antiretroviral therapy were to receive it in a timely fashion, vacancy rates at the end of five years should be 10 percent to 15 percent lower than they would be in the absence of such treatment.

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