Human Capacity Development in HIV/AIDS

Human Capacity Development is a broad-based strategy to enhance a nation’s workforce by linking policy, health care facilities, and the community. This involves the enhancement and coordination of skills training, recruitment practices, management systems, and policy measures for an effective response to HIV/AIDS at all levels. Examples of human capacity development approaches include staff recruitment and retention procedures, effective human resource policies, training and utilization of community volunteers, performance improvement strategies, pre-service education, and leadership development.

Why is human capacity development important for an effective response to HIV/AIDS?

An inadequate number of well-trained, highly motivated providers has long been a major obstacle to accessible, quality healthcare in developing countries. In Africa particularly, this problem has reached crisis proportions. The AIDS pandemic is greatly increasing the number of people requiring care, increasing stress on these overburdened healthcare delivery systems and providers. Simultaneously, doctors, nurses, and midwives are often not providing care because of the stigma associated with AIDS patients, are absent from work to care for a sick family member, are themselves infected with HIV, or have left their countries to seek work abroad. Human resources are being eroded just as countries increasingly need them to provide a growing number of services.

The President’s Emergency Plan for AIDS Relief contains a strong treatment component, aiming to treat at least two million people with antiretroviral therapy. In order to dispense and oversee antiretroviral therapy and antibiotics and mobilize communities to care for those affected by AIDS, human capacity development will be more important than ever. It is therefore imperative to incorporate human capacity development strategies into the design and implementation of HIV/AIDS programs in order to ensure the availability of adequate human resources to deliver prevention, care, and treatment services.

What are some of USAID’s current activities in human capacity development?

Twinning Center—The Twinning Center is designed to support the development of human capacity by partnering international institutions with those in the developing world. Through mentorship, the Twinning Center will support human and institutional capacity building using exchanges, training, technical assistance, internships, communications and information support, telemedicine, and commodity support. It will also support the deployment of highly skilled volunteers. The Twinning Center will be jointly implemented by USAID and the Health Resources and Services Administration, beginning in 2004.

Quality Assurance—USAID aims to look beyond the mere presence of health care providers to ensure the quality of services that they are providing. Specific work in this area includes estimating workforce requirements, developing and evaluating tools and job aids, examining the cost-effectiveness of training strategies, and creating local forums to share best practices.

USAID funded the completion of a workforce study in Zambia that analyzed staffing needs and the related cost implications of plans to scale-up services in voluntary counseling and testing, prevention of mother-to-child transmission, and provision of antiretroviral therapy. This study has enabled the Government of Zambia to make data-based decisions as they move forward with these expansion plans. USAID is now replicating this study in Rwanda.

Software Modeling—Donors and host country governments often set ambitious goals for public health initiatives, including HIV/AIDS treatment, prevention, and care. However, funding is finite and it is difficult to know if a target is attainable within the given budget. To bridge this gap, USAID has sponsored the development of two software tools that estimate the total cost of a desired result in a specific country context. The first addresses this question across all health disciplines and contains a sub-section on staffing implications and training needs of the initiative. The second model is specific to programs providing antiretroviral therapy and includes issues relating to infrastructure, equipment, lab tests, drugs, care providers, and other human resources.

Self-Assessment Tool—USAID sponsored the development of a manual to help local-level health managers assess the human resource needs in their facilities and then prioritize required interventions. The tool has been distributed to 12,000 health managers worldwide.

Training Needs Assessment—USAID supported a training needs assessment in 12 countries in East and Southern Africa, providing USAID and its partners with cohesive information about training needs in the region and resources available to meet them. Through grassroots input, the study found that the most urgent training needs related to current knowledge of HIV/AIDS, counseling and communication, and program management.

Antiretroviral Therapy—In order to lift the constraints imposed by limited human resources, USAID examined four clinics providing antiretroviral therapy in Kenya. The key finding of the assessment was that despite the presence of qualified medical staff in country, a government hiring freeze prevented facilities from eliminating their staff shortages. Additionally, USAID is involved in supporting the Kenya Medical Training College with technical and logistical support in HIV/AIDS.

Donor Coordination—In late 2003, representatives from the Global Fund to Fight AIDS, TB and Malaria, the World Bank, the World Health Organization, and the U.S., British, and Japanese governments convened to discuss a coordinated response to the workforce crisis in developing countries. Participants identified areas where donors must be involved, including recruitment and retention, performance monitoring, management capacity, in-service and pre-service training. By harmonizing policies and approaches, donors are seeking to mitigate the challenges in human capacity development.

February 2004