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Human resources needs for universal access to antiretroviral therapy in South Africa: a time and motion study

Jan AC Hontelez123, Marie-Louise Newell1, Ruth M Bland14, Kristen Munnelly1, Richard J Lessells15 and Till Bärnighausen16*

Author Affiliations

1 Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa

2 Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands

3 Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Radboud, Netherlands

4 College of Health Sciences, Medical Faculty, University of Glasgow, Glasgow, UK

5 Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK

6 Department of Global Health and Population, Harvard School of Public Health, Boston, USA

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Human Resources for Health 2012, 10:39  doi:10.1186/1478-4491-10-39

Published: 30 October 2012



Although access to life-saving treatment for patients infected with HIV in South Africa has improved substantially since 2004, treating all eligible patients (universal access) remains elusive. As the prices of antiretroviral drugs have dropped over the past years, availability of human resources may now be the most important barrier to achieving universal access to HIV treatment in Africa. We quantify the number of HIV health workers (HHWs) required to be added to the current HIV workforce to achieve universal access to HIV treatment in South Africa, under different eligibility criteria.


We performed a time and motion study in three HIV clinics in a rural, primary care-based HIV treatment program in KwaZulu-Natal, South Africa, to estimate the average time per patient visit for doctors, nurses, and counselors. We estimated the additional number of HHWs needed to achieve universal access to HIV treatment within one year.


For universal access to HIV treatment for all patients with a CD4 cell count of ≤350 cells/μl, an additional 2,200 nurses, 3,800 counselors, and 300 doctors would be required, at additional annual salary cost of 929 million South African rand (ZAR), equivalent to US$ 141 million. For universal treatment (‘treatment as prevention’), an additional 6,000 nurses, 11,000 counselors, and 800 doctors would be required, at an additional annual salary cost of ZAR 2.6 billion (US$ 400 million).


Universal access to HIV treatment for patients with a CD4 cell count of ≤350 cells/μl in South Africa may be affordable, but the number of HHWs available for HIV treatment will need to be substantially increased. Treatment as prevention strategies will require considerable additional financial and human resources commitments.

Human resources for health; HIV; South Africa; Antiretroviral treatment