Lessons for the Future: Adaptations of the health workforce for HIV service delivery in the era of COVID-19

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Authors: Paula Gutierrez Aldama, Pathways Intern; Sarah Ackerman, PhD, AAAS S&T Policy Fellow; Diana Frymus MPH, Health Workforce Branch Chief


The COVID-19 pandemic has created unprecedented challenges for maintaining HIV services for clients and has forced healthcare workers around the world to seek out of the box solutions. These adaptations and innovations are crucial considerations for the future of the health workforce as we seek to combat this pandemic and prepare for future challenges. This blog examines the role of the health workforce and lessons learned in maintaining HIV services during COVID-19, and how they are positively changing the landscape of HIV service delivery.

COVID-19 has exacerbated the pre-existing global healthcare worker shortage; 70 percent of countries surveyed by the World Health Organization reported insufficient staff availability as a key reason for the interruption of essential health services during the pandemic. Healthcare workers have been reassigned to support the demands brought upon health systems by COVID-19. This shift in capacity has been followed by innovative adaptations to HIV service delivery in order to ensure the most efficient use and availability of healthcare workers. These adaptations include remote monitoring of patients, home delivery of refills, and virtual consultations.

USAID Afya Endelevu Nurses pose for a photo during a recent  course on  COVID-19 vaccine provision  held in Zanzibar  Islands, Tanzania. The Nurses are part of 100 HCWs contracted in November 2021 to support Emergency Responses  to COVID-19 in high risk areas in the Isles.
USAID Afya Endelevu Nurses pose for a photo during a recent course on COVID-19 vaccine provision held in Zanzibar Islands, Tanzania. The Nurses are part of 100 HCWs contracted in November 2021 to support Emergency Responses to COVID-19 in high risk areas in the Isles.
Photo Credit: Benjamin Mkapa Foundation

Lessons Learned For the Future

The challenges the COVID-19 pandemic has imposed on HIV service delivery have revealed valuable lessons for governments, healthcare workers, and local partners.

Local partner involvement: Due to their presence within communities, local partners have a unique ability to influence healthcare work conditions and deliver services. Local partners can inspire change and drive the development of sustainable solutions by advocating for policies at the local-government level to ensure a safe environment for workers.

Investing in health systems: COVID-19 has highlighted the need to invest in the health workforce, through investments in worker recruitment, monitoring health workforce data systems, building a sustainable supply of workers, developing policies to support workers, and investing in the retention of workers by creating safe and motivating work environments. These types of investments are crucial for countries to be able to sustain the gains they have made this past year thanks to the innovations and adaptations of the health workforce.

Private sector involvement: The Private sector has a critical role to play in addressing the COVID-19 pandemic and preparing for future challenges. Unjani clinics, a network of over 96 nurse owned and operated private clinics in South Africa, have had an exemplary response during COVID-19 and have remained open throughout this time as an essential service. Unjani has prioritized the safety of their staff by ensuring the availability of PPE and sanitation equipment for clinics. Unjani nurses have been able to disseminate information easily within their networks and incorporate COVID-19 protocols effectively and quickly. The Unjani model is crucial in South Africa, where over 80 percent of the population relies on public provision of health services.

Unjani clinics have also helped combat increases in youth unemployment by placing 50 youth workers in their clinics through the Youth Employment Scheme, a private partner which helps connect youth with employment. By removing the burden of paying for the youth workers, this partnership allows the Unjani clinic nurses to take on more staff without risking their own resources.

Finally, ensuring protection and wellbeing along with the addressing issues pertaining to inadequate numbers of staff are the main struggles for health workers during the COVID-19 pandemic. The private sector has a valuable role to play in providing funding to resolve these issues.

USAID Afya Endelevu  laboratory Scientist, Mr. Elias Mariki, processing HIV viral load samples in the PCR Laboratory at Ligula Regional Referral Hospital in Mtwara Region, Southern Tanzania.
USAID Afya Endelevu laboratory Scientist, Mr. Elias Mariki, processing HIV viral load samples in the PCR Laboratory at Ligula Regional Referral Hospital in Mtwara Region, Southern Tanzania.
Photo Credit: Benjamin Mkapa Foundation

The learnings and lessons from this blog were presented at this year’s International AIDS Society (IAS) Conference on HIV Science, PEPFAR health workforce experts, USAID’s Diana Frymus and Sarah Dominis from the U.S. State Department’s Office of the Global AIDS Coordinator, were joined by panelists to discuss the crucial role of healthcare workers in maintaining HIV services during the COVID-19 pandemic. The recorded session is available online.

Guest speakers included Ms. Lynda Toussaint, CEO of Unjani Clinics NPC in South Africa, Ms. Agatha Nthete, a Nurse-Midwife Technician in Malawi, Dr. Goodluck Mwakitosha, Program Manager of the Benjamin Mkapa Foundation in Tanzania, and Dr. Llang Bridget M. Maama-Maime, National Tuberculosis Program Manager and Disease Control Director for Lesotho.

In the past year and a half, healthcare workers have shown unparalleled dedication in the face of the COVID-19 pandemic. This IAS session highlights the incredible innovations and lessons learned, which are now positively changing the landscape of HIV service delivery. The health workforce expert’s testimonies in this session remind us that it is imperative to remain vigilant and prepare now for future challenges.

Last updated: December 08, 2021

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