“Conditional scholarships” for HIV/AIDS health workers: educating and retaining the workforce to provide antiretroviral treatment in sub- Saharan Africa

In spite of recent large-scale efforts to roll out ART in developing countries, millions of people who need ART currently do not receive it. Without large increases in the number of health workers to treat HIV/AIDS (HAHW) in the next few years, most developing countries will be unable to achieve universal coverage with ART, leading to large numbers of potentially avoidable deaths. We investigate the economic value of a scholarship for health care education that is conditional on the recipient entering into a contract to work for a number of years after graduation delivering ART in sub-Saharan Africa. Such a scholarship could address two of the main reasons for the low numbers of health workers in developing countries. First, the “scholarship” could increase the number of health workers educated in the country. Second, the “condition” could decrease the probability of emigration of HAHW. We use Markov Monte Carlo microsimulation to estimate the expected net present value (eNPV) of “conditional scholarships” in sub-Saharan Africa. We find that under a wide range of plausible assumptions the scholarships are highly eNPV positive. “Conditional scholarships” for a team of health workers sufficient to provide ART for 500 patients have an eNPV of 1.23 million year-2000 US dollars, assuming that the scholarship recipients are in addition to the health workers who would have been educated without scholarships and that the scholarships reduce annual HAHW emigration probabilities from 15% to 5% for five years. When individual variable values are varied from this base case within plausible bounds suggested by the literature, eNPV of the “conditional scholarships” never falls below 0.5 million year-2000 US dollars. When we assume that the scholarships do not increase HAHW education output, but merely reduce annual HAHW emigration probabilities from 15% to 5% for five years, their eNPV remains highly positive at 0.29 million year-2000 US dollars. Although the “conditional scholarships” are a socially desirable investment, implementation success will likely depend on the sources of finance, selection of candidates, specification of the condition, enforcement mechanisms, and supporting interventions.