TORONTO, Canada (AFP) – Developing countries that are worst hit by AIDS need more than four million health workers to help cope with the crisis, the World Health Organisation (WHO) said Tuesday.

The crippling shortage of doctors, nurses and other caregivers has been spurred by a brain-drain of talent to richer countries, but also by death among health workers from AIDS itself, the organisation revealed.

Sub-Saharan Africa, home to an estimated two-thirds of the nearly 39 million people living with AIDS or the virus that causes it, faces the severest shortage.

In a blueprint presented at the 16th International AIDS Conference, the WHO said that tackling the personnel shortfall would cost a minimum of US$7.2 billion dollars over the next five years, in the 60 countries with the highest HIV/AIDS burden. At the top end of the scale, the bill would be as high as US$14 billion dollars.

“The shortage of health workers is devastating public health systems, particularly in the developing world, and it is one of the most significant challenges we face in preventing and treating HIV,” said WHO assistant director-general, Anarfi Asamoa-Baah.

The WHO report, “Treat, Train, Retain,” puts the spotlight on skilled medical workers in Africa who have been lured abroad, ironically, most often, to the United States and Europe, which have donated most to combating AIDS.

In South Africa, for example, 37 per cent of locally trained doctors are working outside the country, while the figure for nurses who trained in Zimbabwe is 34 per cent.

But health workers can also be lured to non-governmental organisations (NGOs) which operate within their countries, thus contributing to the public-health service crisis.

“For example, within one year, the Masaka region of Uganda lost 10 of its 21 doctors, newly trained in HIV skills, to programmes run by NGOs in the region,” the report noted.

Key personnel can be encouraged to stay through salary increases and fringe benefits, such as help with housing costs, travel, credit, school fees and child care, it suggested.

The difference between WHO’s US$7-billion and US$14-billion estimates, depends primarily on whether there is a doubling or a five-fold increase in salaries.

AIDS itself is a major risk for health workers, who are exposed to infection by needle-stick injuries and contaminated blood and other body fluids. Each year, approximately 1,000 infections of this kind occur among health workers, mostly in low and middle income countries where hospitals often lack safety equipment, such as gloves and special boxes, to dispose of used syringes.

The WHO said AIDS-ravaged countries were trapped in a vicious cycle.

“Weak health systems mean low coverage of HIV services. Prevalence rises, which, in turn, places an increased burden on the health services,” WHO said. “An ailing health workforce further undermines already weak health systems, and weak health systems result in an inadequate response to the HIV epidemic.”