A close-up image of hands with latex gloves preparing a lab test.

Closing the Gap in HIV .

A new tool from the President’s Emergency Plan for AIDS Relief (PEPFAR), tested in Malawi and Zambia, brings the HIV landscape into focus by unearthing data to address current staffing challenges in HIV healthcare facilities.

Low- and middle-income countries often face a shortage of qualified health workers who can deliver life-saving HIV services. Given the global goal of achieving an AIDS-free generation by 2030, health facilities must ensure that workers with the right mix of skills are available to address specific health needs. In communities with high numbers of people living with HIV, health facilities need workers along the continuum of care who can provide testing, counseling, and proper care and treatment.

To prepare the HIV workforce to provide these services, health facility managers must have reliable data about staff members’ skills and training needs as well as barriers to service delivery. However, most of the high-burden HIV countries prioritized by PEPFAR lack the data necessary to make sound management decisions in health facilities. Without reliable data, for example, it is difficult to determine why clinics cannot retain staff or why the demand for HIV care is low.

“Health facility managers often lack the data they need to make smart staffing decisions,” explained, Jim Griffin, project director for USAID’s HRH2030 program (Human Resources for Health in 2030).

In 2016, the HRH2030 program, through PEPFAR, supported the application of a new rapid site-level assessment tool that collects health workforce data across facilities to identify human resources-related bottlenecks to HIV service delivery. The assessment tool measures the adequacy of human resources at health facilities and identifies barriers that get in the way of delivering quality HIV services. Following an assessment, armed with concrete data about staff effectiveness and service barriers, health facility managers can make more informed choices about staffing numbers and placements. They can also identify areas that require further investigation and intervention.

“Health facility managers often lack the data they need to make smart staffing decisions. This type of assessment is relatively easy to do and can reveal bottlenecks to quality HIV care.”

Jim Griffin, project director for USAID’s HRH2030 program

“This type of assessment is relatively easy to do and can reveal bottlenecks to quality HIV care,” Mr. Griffin noted.

HRH2030 used the PEPFAR Rapid Site-Level Assessment Tool in Malawi and Zambia, two high HIV burden countries: The tool was applied to 110 facilities in three districts in Malawi in May 2016 and to 100 facilities in 17 districts in Zambia from July to August 2016.

A local data collection firm carried out the assessment in both countries, using a questionnaire provided by HRH2030. Interviewers spoke with facility managers and team leaders, asking questions about health care workers in a variety of HIV service-delivery roles, such as clinicians, laboratory technicians, pharmacy technicians, and community health workers. HRH2030 staff created a database to store the resulting information and shared survey answers with project stakeholders in reports. In short, the assessment discovered priority challenges to HIV service delivery at the facility level, providing decision-makers in Malawi and Zambia with key information to improve their HIV services.

In Malawi, project staff found that inadequate space and a shortage of health care workers were the major barriers to successful HIV service delivery. Health workers often quit their jobs due to excessive workload, poor working conditions, few promotion opportunities, and a lack of supplies.

In Zambia, staff members’ main reasons for leaving differed. Supervisors sometimes assigned staff to positions for which they were not trained. Meanwhile, other staff found better opportunities in the private sector, and still others were reassigned elsewhere by the government.


facilities in three districts in Malawi applied the PEPFAR Rapid Site-Level Assessment Tool


facilities in 17 districts in Zambia applied the PEPFAR Rapid Site-Level Assessment Tool

These findings are helping to shape decision-making around Malawi’s HIV program human resources. Additionally, in December 2016, HRH2030 finalized a report detailing lessons learned during the application of the PEPFAR assessment tool in both countries and recommendations for Malawi, Zambia, and other low- and middle-income countries seeking to conduct similar assessments. The report includes, for example, suggestions for planning prior to the assessment and options for the data collection process.

In applying the rapid site-level assessment tool, HRH2030 expanded the amount of data available to stakeholders for addressing pressing human resource needs in HIV/AIDS treatment and prevention. Using this type of assessment data to improve HIV service delivery sites brings us one step closer to an AIDS-free generation. And although PEPFAR originally created this tool specifically for HIV, it may also have applications beyond HIV treatment and prevention; future practitioners could modify it to gather data on maternal, newborn, and child health as well as on other communicable and non-communicable diseases. No matter the medical need or geographic region, HRH2030’s lessons show that accurate data leads to better decision-making around human resources for health.