In April, I visited two government health centers in Ethiopia where IntraHealth works to strengthen prevention of mother-to-child transmission (PMTCT) of HIV. In 24 months, almost 2,000 babies have been delivered there. Thirty of the mothers were found HIV-positive, but only one of the babies was positive. That baby is on antiretroviral therapy (ART) and doing fine.

IntraHealth has played a catalytic role in scaling up PMTCT in Ethiopia: When IntraHealth started working in PMTCT in 2003, there were no PMTCT services at any government clinic in Ethiopia. Now IntraHealth supports these services in 511 clinics. None of that would have been possible without frontline health workers who are, as IntraHealth likes to say, present, ready, connected, and safe.

• Present, meaning they are working where they are needed most
• Ready, meaning they are equipped with the knowledge, skills, and support they need to succeed
• Connected, meaning they are connected to technology and linked to networks in their communities and the rest of the world
• Safe, meaning they are empowered to provide health care for their communities.

The global shortage of health workers is estimated at over 4 million, with 57 countries experiencing an acute shortage—defined as fewer than 2.3 doctors, nurses, or midwives per 1,000 people. This translates into nearly a billion people who have no access to a health worker of any kind—one-seventh of the world’s population.

Evolving Roles for Health Workers

As we approach the 2012 International AIDS Conference (IAS) in Washington, D.C. July 22–27, it seems an opportune time to reflect on the critical role that health workers play in HIV/AIDS prevention, treatment, and care services. The conference theme, “Turning the Tide Together,” makes the point that “seizing this potential and actually turning the tide on HIV and AIDS will require commitment and action on many levels: that each and every stakeholder in the HIV and AIDS response must play their role.”

This tide will not be turned without more support for the frontline health worker.

The frontline health worker is especially important in sub-Saharan Africa where the impact of AIDS conspires with health worker shortages to threaten the ability of health systems to cope. A resurgence of tuberculosis, a common HIV co-infection, is worsening the situation.

As approaches to HIV/AIDS evolve—with new strategies such as “treatment as prevention” and medical male circumcision—we need to ensure that frontline health workers have the skills and support they need to provide health services for those who have no other access to health care.

Also evolving are the roles of the different types of health workers—doctors, nurses, midwives, clinical officers, rural medical practitioners, and others—due to “task-shifting,” which the World Health Organization defines as “the rational re-distribution of tasks among health workforce teams” in which specific tasks are moved from highly qualified health workers to those who have fewer qualifications in order to make more efficient use of available resources.

In some cases, whole new cadres of health workers are being created to cope with emerging needs. In Tanzania, for example, the government, in collaboration with IntraHealth, has developed voluntary para-social workers and para-social worker supervisors to care for and support the country’s most neglected and vulnerable children, many of whom are orphaned due to AIDS.

How IntraHealth Supports Health Workers to Combat HIV/AIDS

IntraHealth’s work with health workers, especially in Africa and Central America, is making a difference. In 2011, health workers supported by IntraHealth helped:

• 913,592 people receive HIV counseling and testing
• 408,376 pregnant women receive PMTCT services
• More than 3,000 HIV-positive pregnant women receive ART.

IntraHealth did this, and more, through projects supporting HIV/AIDS and tuberculosis clinical services in 13 countries in Africa (Ethiopia, Kenya, Namibia, Rwanda, Tanzania, South Sudan, Uganda, Zambia) and Central America (Belize, Costa Rica, El Salvador, Guatemala, Panama). These projects are funded by the U.S. Agency for International Development and the U.S. Centers for Disease Control and Prevention.

IntraHealth has developed a variety of innovative strategies for improving the response to HIV/AIDS prevention, care, and treatment by supporting health workers. The examples are ample. Here are a few:

• Door-to-Door HIV Testing: To increase access to HIV voluntary counseling and testing (VCT) in rural Zambia where health workers are in short supply, IntraHealth has trained community members as “lay counselors,” providing them with bicycles, rapid test kits, and data collection forms to provide door-to-door VCT, which has been provided to 150,395 individuals in three years.
• mHealth Solutions: In Costa Rica, El Salvador, and Guatemala, IntraHealth trains health workers to provide HIV/AIDS services using eLearning and mobile devices. In Uganda, IntraHealth has used health provider records to launch a mobile directory that Ugandans can access via their cell phones to verify health professionals’ credentials and avoid “quacks.”
• Knowing Their HIV Status at Delivery: As part of its work in Namibia to build the capacity of national organizations, IntraHealth trains district health staff in using its Performance Improvement approach. The approach helped the district health teams to lower the number of pregnant women who do not know their status at delivery from 21% to 6% in a year.
• Provider-Initiated HIV Testing and Male Circumcision: In Tanzania, IntraHealth has reached more than 574,000 people with an innovative provider-initiated HIV counseling and testing at hospitals, health centers, and dispensaries, and IntraHealth has reached 37,900 men and boys with medical male circumcision, far exceeding project goals.

Read more about how IntraHealth supports health workers to combat HIV/AIDS.

On July 26 at IAS 2012, IntraHealth’s CapacityPlus will host a satellite session on the health supply chain workforce. The session will be moderated by Pape Gaye, president and CEO of IntraHealth.

Read more about IntraHealth’s participation in IAS 2012.