Pia Schneider, PhD, Abt Associates, 4800 Montgomery Lane Suite 600, Bethesda, MD 20814, (301) 347-5340, pia_schneider@abtassoc.com

Issues: As the global community attempts to scale-up interventions to address the HIV/AIDS epidemic, there is increasing awareness of the barriers that weak health systems pose to the success of such interventions. Description: This study evaluates the impact of one such mechanism for scaling up (The Global Fund to Fight AIDS, TB and malaria) on a critical aspect of the health system: human resources. The findings are based on document review, baseline facility surveys and one smaller scale follow-up survey, individual provider surveys and in-depth interviews with key informants, in a total of six different countries. Lessons Learned: Grants from the Global Fund typically include extensive training activities for health workers. Few address issues of staff retention and motivation. In cases where Global Fund activities pay health workers higher incomes than regular health workers, substantial concerns arose about equity and demotivation of regular health workers. In countries where health workers are in short supply, Global Fund supported activities may over-burden capacity and cause shifts in the distribution of health workers’ time from non-focal to focal disease programs and functions, and contribute to worker stress. Issues of geographical equity arise, particularly in the context of antiretroviral programs that attract skilled staff and are typically initiated in provincial hospitals. Recommendations: While efforts to scale up priority services (such as HIV/AIDS care) may potentially benefit health workers and the broader health care system there are also many possible negative effects. Careful monitoring of interventions is important to protect against such negative effects.

Learning Objectives: