Exploring the Frontier: A Firsthand Perspective on Health Workforce Challenges in South America

January 2012 by Amanda Puckett with Anne Wilson
TAGS: Health Service Delivery, Health Workers, LAC Bureau

Remote regions of the world often face the most challenges accessing health services and health workers. In the frontier areas on the border of Bolivia and Peru, these difficulties are anticipated to intensify with the completion of the transoceanic highway. Intended to link South American ports on the Pacific and the Atlantic oceans, the highway will open this rural frontier to increased commerce, traffic and migration, as well as an increased demand for health services. Consequently, with the opening of the highway, incidence of HIV/AIDS, tuberculosis, and other communicable diseases will likely increase. 

CapacityPlus recently conducted a study to learn more about the health workforce providing HIV/AIDS services in this region. Anne Wilson led the team that collected data in Madre de Dios, the Peruvian zone on the borders of Brazil and Bolivia, and, along with the other three team members, facilitated a dissemination workshop that presented findings and recommendations. Anne’s resume is full of high-level HRH experience, including serving as director of the Capacity Project.

I recently had the opportunity to chat with Anne about the exciting study and learn more about HIV/AIDS services in this remote part of the world, the challenges facing the health workforce, and how the health workforce is positioned to respond to the anticipated changing health needs associated with the opening of the transoceanic highway.

Tell me about your experience collecting data in the region and what kinds of HIV/AIDS prevention and treatment services are currently available.
The data gathering tools were adaptations of the HRH Action Framework developed by the Global Health Workforce Alliance with support from Capacity Project. The methodology was a combination of an interview tool used with service providers and managers at several levels and a site assessment that identified equipment, supplies, and other supportive systems needed to provide services. Currently, most HIV services in this area are directed at preventing the vertical transmission of HIV from pregnant women to newborns. Other testing and outreach is very limited. There are acute shortages of health workers and serious deficits in the supportive environment.

Describe the work environment supporting health workers in these areas.
Many of the sites have no communication system, and lack access to consistent clean water. There are significant gaps in equipment and supplies, including those for HIV prevention and testing. Transportation for patients is rarely available unless clients can provide it for themselves. Health workers in remote areas are supposed to receive additional pay but, especially in Peru, this does not always happen. On top of this, opportunities for continuing education are very limited and supportive supervision, while available, tends to focus primarily on record keeping rather than efforts to ensure health workers remain technically competent or learn new skills. As a result, many providers had not been prepared to treat or refer HIV patients.

What kinds of challenges does the transoceanic highway pose for the health workforce in the region?
The transoceanic highway will facilitate transport from one area to another and thus has the potential to shorten the time needed to move high risk or emergency patients from the more remote areas to reference hospitals or centers. It also has the potential to create more health services along the road. On the other hand, it is already contributing to an increase in the overall demand for health services including those related to vehicular accidents. Most health workers in the area currently lack skills in managing trauma and emergency transport. Other worries are that the highway may introduce new or emerging health issues not currently recognized—increasing the overall volume of mobile populations and environmental degradation due to increased pollution can foster higher rates of respiratory illnesses, tuberculosis, etc. There is also concern about an increase in sex trafficking as well as overall human trafficking.

For you, what was the highlight of the dissemination workshop?
The workshop brought together service providers, managers, district officials and university faculty who were part of the initial interviews. They were very energized and were able to prioritize some of the recommendations, such as establishing a functional communication system and exploring a regional approach to addressing key issues.

The study and workshop were funded through USAID’s Latin America and the Caribbean (LAC) Bureau.

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Photo by Carol Bales.