ART has the potential to transform the experience of living with HIV/AIDS in countries such as Mozambique with 1.4 million HIV-positive people, more than 300,000 of whom are presently in need of treatment. Since 2004, the Mozambican government, with the support of the international community, has been pursuing an ambitious plan to expand access to ART, yet there are 0.2 doctors and 2.8 nurses and midwives for every ten thousand people in the country. The aim of this report is to provide a situational analysis of present human resource constraints of expanding ART in Mozambique and critically discuss strategies and actors involved in facing the challenge. Methods A case study of HRH of ART delivery in Mozambique was conducted in order to analyse the present situation in relation to the human resource requirements of providing ART. This case study is interspersed with a selective literature review of HRH and ART in sub-Saharan Africa intended to provide a broader context for the findings. Findings Recent estimates of the human resource requirements of ART were related to HRH availability; in 2008, almost all of the doctors (82%), medical officers (96%) presently available in the country will be required to meet treatment goals. Without the inclusion of basic-level personnel, ART HR needs for pharmacy technicians (214%) greatly exceed availability. Several responses to the HRH crisis have been proposed, including increasing supply, task-shifting, and optimizing available health care workers; but an adequate response will require stronger commitment from international and national actors.

Conclusions:

HRH are one of the principle constraints on the expansion of ART Mozambique. Without a concerted effort and innovative solutions, ART will consume and in some cases exceed the available health workforce in the country. Responses to HR challenges depend on the international community, national and local authorities, and civil society.