ARTICLES
EMPOWERING YOUTH TO OVERCOME HEALTH WORKFORCE SHORTAGES
This report brief discusses how sub-Saharan Africa has the opportunity to confront a human resources for
health shortage and reduce HIV exposure among adolescents through the engagement of youth within
the formal economy. Three problems are identified 1) a growing employment crisis, as a steadily increasing
population of youth enter the labor force each year that far exceeds the number of jobs created; 2) the
swelling population of adolescents and young adults who have a disproportionately higher risk of HIV
acquisition; and 3) health and social service workforce is inadequate to meet population needs in many
countries.
The brief argues that Health and social services jobs have good potential for youth employment. The
majority of these jobs are produced by the private sector, which has shown to promote young women,
thereby reducing their vulnerability to HIV. However, youth from disadvantaged backgrounds remain
unaware. The article encourages investment in the below areas to engage youth in health sector jobs.
• career exposure and education for health and social services;
• math and science skill development for youth interested in careers in health;
• access to quality health training programs (e.g. expanding accreditation and financial aid);
• Technical and Vocational Education Training system capacity building and reform;
• improved public sector management practices that promote youth employment in paraprofessional
occupations; and
• job creation and entrepreneurship initiatives within health value chains showing high potential,
such as pharmaceuticals and medical tourism.
From the report reviews of different work engagement programs they recommends four key drivers of
success for youth health workforce training and employment programs:
1. Availability of Good Jobs: youth can find quality employment in selected fields
2. Buy-in From the Professional Council: youths’ qualifications meet industry requirements
3. Participation of Committed, Qualified Trainers: youth are trained and coached by health
professionals
4. Clear Articulated Pathway for Professional Development: youth may achieve upward mobility in
their fields through experience and further training
EGPAF PRESENTATIONS
EGPAF Research Dept. Evidence to Action – Adolescents Presentations
 Understanding Adolescents Perspectives of HIV Services
o Adolescents Do Not Receive Early (Pre-testing) Messaging about
Living a Long, Healthy life on ART.
o First interaction with health staff is important as an entry point to
testing
o Messages outside of health facilities need to include information
on:
 Living a long and healthy life on ART, with emphasis on
being able to live a ‘typical life’ and obtain goals such as
marriage, children, education and a career
 The benefits of knowing one’s HIV status
 Realities of living with HIV (to reduce misconceptions)
 Impact of a Comprehensive Adolescent-Focused Case Finding
Intervention on Uptake of HIV Testing and Linkage to Care Among
Adolescents in Western Kenya
o Three-fold Increase in HIV Testing with dispensaries accounting for
greatest increase in total HIV Tests and Total HIV-positive tTests
o The proportion of HIV-positive adolescents linked to care
significantly increased from 61.6% to 94.0% (p<0.001).
o Decentralization to lower level facilities, such as dispensaries, was
critical to improving identification and linkage rates.
Link to presentation recording here
JOURNALS & WEBCASTS
Strengthening Local Capacity for community led response to the HIV epidemic
among key populations – LINKAGES
 Global survey done to understand what type of support CSO preferred
 from INGO.
Full Assessment: USAID Youth Power Action South Africa Health Workforce Assessment
 Top 6 type of assistance CSO found to be valuable:
CASE STUDY: Kheth’Impilo Pharmacy Assistant Learnership Program 1. Financial Assistances - grants and awards
The assessment highlights the Kheth’Lmpilo program in South Africa. The organization recognized that 2. Technical Assistance
pharmacy support personnel were needed in South Africa to strengthen pharmacy services. To address the 3. Staff Training
issue, the organization created a training program that is accredited by the South African Pharmacy 4. Review and feedback on material, reports, approaches
Council. The formal accreditation allows graduates to easily enter the formal economy. To date over 800 5. Program assessments or reviews
youth from vulnerable communities have participated in the program with 443 receiving a post-basic 6. Tools and resources and KP-specific guidance
pharmacy assistant qualification and the remainder the basic pharmacy assistant certification. Nearly all
 Top three most valuable capacity strengthening areas:
program graduates are working; most in the public sector with the rest either in the private sector or
o Monitoring, Evaluation and Learning
continuing their studies.
o Financial Management
The program serves two key purposes. First, it eases the load on pharmacists (who are in short supply) o Service Quality and Delivery
and allows for more cost-effective service delivery. With 7 million people living with HIV (PLHIV) in South
 Indonesia, Jakarta – on track to reach 90s but Key Populations lag behind –
Africa, Pharmacy Assistants can support differentiated models of care. Second, this program allows
marginalized youth to enter the health sector with an average monthly salary of R15,000 (US$1,276). 20% of PLHIV
Kheth’Impilo has estimated that the program has generated an annual R79 million (US$6.7 million) back o Program found that CSO participants or Learners need to be
into the community through salaries. engaged in the Process to ensure good capacity building. LINKAGE
is doing this through:
EGPAF Example: In Malawi, the country program supported a Medical Assistances (MA) and Nurse Midwife
 Learning Communities through WHATSApp
Technician (NMT) fellowship with the MoH. The program was an outcome of an assessment done by EGPAF
and the MoH that looked at districts and their HRH levels. Based on the assessment, the MoH and EGPAF  Quarterly learning, coordination and reflection
created a fellowship for applicants from rural districts to become MA and NMT to fill critical gaps in their consultations
districts. EGPAF provided funds to the training institutions and travel stipends to the fellows. Once they  Differentiated Outreach Approach: Trainings build on each
graduated they were to be absorbed into the MoH system. other and customized to needs; lots of on the job training
 Simplification of outreach tools
Leveraging the Private Health Sector to Expand the HIV/AIDS Workforce – SA and India
o The project monitors success through three Performance
SHOPS Plus (USAID Project) did a qualitative study of to evaluate how the private health sector can support Thresholds or indicators
the fight against HIV. The assessment reviewed programs in South Africa and India. The study states that  At least 60% of eligible key populations test for HIV/quarter
few governments are prepared to absorb costs of additional health workers and others expenses to
 At least 6% case finding rate and/or increase in absolute
support the sustainability and long-term maintenance of epidemic control as donor support declines. The
number of HIV positive cases identified/quarter (MSM)
study examines where along the HIV continuum of care private providers would best be used, the
conditions needed for the private sector to invest in staff for HIV-related service delivery, the role of  PEPFAR funded CSO out performed Global Fund CSO
private community-based health workers, and the role of the public sector in strengthening the private under this indicator
health sector’s HIV workforce expansion. The report concludes with recommendations for policy makers,  At least 90% of newly diagnosed key population enroll in
donors, and implementing partners who seek to tap into the private sector to strengthen the HIV response. HIV treatment services
The study highlights the below case study, as a good example in how to expand basic health services within  Kenya - Bar Hostess Empowerment and Support Program (BHESP)

the community, and promote job creation.
CASE STUDY: The Unjani Clinic Network/Non-Profit Company
The Unjani Clinic Network is a social franchise with three objectives: 1) to empower its professional nurses
by providing them with infrastructure, entrepreneurial opportunities, and skills to establish and grow
businesses in their communities; 2) to create permanent jobs for the nurses, who are the owners and
operators of the individual clinics, and the staff they employ; and 3) to create a sustainable model for
primary health care. The social franchise shifts primary health care tasks to professional nurses, who are
the owners and operators of the individual clinics. The nurses are residents of their community, and with
their community-level service delivery, build trust and their reputation.
Clinics are strategically located in low-income areas where need is high and access to other options for
care is limited. Before the clinic is established, each nurse must conduct a household survey that shows
that at least 200 people will seek care from the clinic and be able to pay for it. As word about a new clinic
spreads in the community and the clinic attracts more patients, the nurse hires more health workers,
mainly support staff (clinic assistants) and other nurses in accordance with a predetermined ratio of 30
patients a day per nurse. The nurse’s salary grows, from a starting rate below that of government nurses to
one that is higher, and, in a few cases, double. Patients are generally employed but uninsured, so many
earn government stipends. They primarily pay with cash.
All clinics provide a standardized list of affordable primary health care services, including basic ultrasound
and laboratory services. Unjani provides services across the HIV clinical cascade: counseling, testing, and
ART. The majority of nurses have been trained or are receiving training in nurse-initiated and managed
ART (NIMART). For any services they do not provide, Unjani nurses refer patients to government clinics.
TOOLS
SHOPS Plus Tool - Private Sector Counts: Explore the role of public and private sources of care
The webpage provides data sets on Family Planning and Child Health. You will find information
where and when care givers seek care, and women obtain family planning methods. The data
provide country and regional information. Below are examples of the information and graphics
will find.
o Capacity assessments are important to pinpoint what needs to be
done to strengthen BHESP for improved performance – technical
and operational skills
o Assessments supported improved governance and professionalism
of the BHESP
o After TA from the capacity assessment BHESP was able to
strengthen systems and attracted new donors – USG and INGOs.
This allowed BHESP to expand scope and support beneficiaries in
new ways
 Eastern Caribbean – Prescriptive vs organic: considerations for successful
capacity development approaches with key pops
o Used capacity assessments to decide which CSO to fund and lead
activities for the LINKAGES Project
o Chosen CSO received support by LINKAGES throughout
implementation based on the results of the capacity assessments.
The tailored TA supported good technical outcomes by the CSO.
EGPAF Example: Through the Malawi and Kenya ViiV CBO award, EGPAF teams
have used capacity assessments to provide tailored TA to strengthen community
based organizations operational systems and improve technical skills. The Kenya
ViiV team hosts CBO networking meetings. The Linkage team above found these
types of meetings to be a good way to ensure the “learner” takes responsibility in
building their capacity.
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