In 2017, the President’s Emergency Plan for AIDS Relief (PEPFAR) in Malawi received funding for the recruitment and deployment of health workers to 63 selected PEPFAR priority sites located in areas with the highest HIV/AIDS burden in the districts of Lilongwe and Zomba. The health workers included antiretroviral therapy (ART) providers, testers (lab cadres), and pharmacy cadres. As a result of this deployment, HIV/AIDS care and treatment was expected to increase, thereby improving the availability, utilization, and quality of HIV/AIDS services in the supported sites and enhancing HIV/AIDS and health outcomes overall.
This 2019 impact assessment reveals several positive and statistically significant impacts of the PEPFAR salary support activity on site staffing and HIV/AIDS services. The deployment of these health workers increased the number of health workers providing ART services by 49 percent. It was associated with statistically significant increases in the number of sites providing adult ART, prevention of mother-to-child transmission, and TB screening, at least five times a week. It was also associated with an increase in the number of sites that run ART clinics at least five times a week or more, as well as the percentage of sites using the six-month multi-month dispensing model. The benefits reported by facility and health care workers themselves included reduced work pressure, enhanced teamwork, timely provision of care to clients, and reduced waiting time.
This report also documents the lessons learned and best practices for future considerations for donor-supported salary interventions, including the need to complement these interventions with other, wider human resources for health and health system strengthening interventions in order to enhance and sustain the continued delivery of HIV/AIDS services.