Table 1 Perceptions of necessary workforce inputs

Adequate numbers of workers for workload

HCWs expressed a desire for more HCWs to be available for PMTCT service delivery, as high workload, particularly for midwives and community counselors, is a barrier to PMTCT success.

“There are an insufficient number of midwives. The number of activities and the number of pregnant women is too much for any midwife… To manage these difficulties, the midwives on service must put their heads down and go at the work alone.”—Midwife

Organizational designation of “PMTCT staff”

There was an emphasis on needing to engage all HCWs in PMTCT services, especially the midwives and community counselors.

“[A suggestion to improve PMTCT services is] to involve all the personnel—and above all the midwives—in the management and care of HIV and PMTCT patients because at this site all the PMTCT cases are managed [only] by the head doctor and the community counselor.”—Midwife

Formal training in PMTCT

Expanded involvement of staff working on PMTCT services requires formal training for those not previously trained, and is especially important for midwives, community counselors and nurses.

“[One of the major obstacles to implementing Option B is the] healthcare personnel’s lack of education in managing [PMTCT] patients… few midwives are trained in testing and follow-up of HIV positive pregnant women.”—Doctor

Salary provision and financial means to do work

Several sites noted that HCWs, and community counselors in particular, did not have the supplies or financial means to perform their tasks, such as transportation for home visits.

“[We need] to have a way of funding the support group (transportation, food), which is right now funded by the community counselor, using her own earnings.”—Community counselor