While the U.S. government has helped train more than 140,000 healthcare workers through the U.S. President’s Emergency Plan for AIDS Relief since the program was re-authorized in 2008, Africa still needs more than one million healthcare workers to address a critical shortage, U.S. Global AIDS Ambassador Dr. Deborah Birx said Monday at a Capitol Hill briefing.

Speakers at the briefing, which was organized by the Frontline Health Workers Coalition, IntraHealth, and the Elizabeth Glaser Pediatric AIDS Foundation, said no disease requires more healthcare workers in Africa than HIV.

“HIV requires a highly trained, skilled, competent, sensitive health workforce to achieve prevention and treatment goals,” Kelly Curran, Director of HIV and Infectious Diseases at Jhpiego, said.

Curran described meeting a nurse who works at the medical circumcision program at the Iringa regional hospital in Tanzania, who had received training through PEPFAR. “She herself has conducted over 5,000 procedures, as well as doing HIV testing and counseling,” Curran said.

Having health workers at the right place at the right time is key.

“She does STI screenings, provides condoms, and has been one of many people leading an example of a whole community response,” Curran said.

Without the support of PEPFAR, she added, the nurse could not have done all that she did.

Sheila Bandazi, Chief Nursing Officer for the Ministry of Health in Malawi, recounted how one of her students, who had received training through PEPFAR’s Nurse Education Partnership Initiative, noticed that a patient who was receiving care for a wound was not healing. The nurse urged the patient to get tested for HIV, which turned out positive. The patient was placed on antiretroviral therapy, and the student expressed to Bandazi how grateful he was for receiving HIV counseling training through NEPI.

Ninety-five percent of the healthcare workers trained by PEPFAR are in sub-Saharan Africa, Ambassador Birx said. “Having healthcare workers at the right place at the right time is key,” she said, adding that there’s a mismatch between where trained health workers are and where the burden is.

Referencing the PEPFAR program in Kenya, where 98 percent of patients are located at 28 percent of PEPFAR sites, she said, “We have been working at sites where there’s no HIV. We have created inequities between programs by overwhelming healthcare workers at areas with high burden of disease.”

The quality of health workers is as important as the quantity.

“We need to align our resources to where the disease is,” Birx said. “With current flat funding, we’re looking at how to do the right things, at the right places, at the right time.”

She added that PEPFAR is looking at site level data to separate high-achieving and low-achieving sites.

“If we find amazing nurses at high-achieving sites, we need to examine the attributes that make them effective,” she said.

Ambassador Birx added that if healthcare workers are trained in HIV care, they can deal with any other disease, including chronic noncommunicable diseases.

Dr. Address Malata, Principal of the Kamuzu College of Nursing at the University of Malawi, said the quality of healthcare workers is as important as the quantity.

Every program in the nursing school has an HIV component, she said, and students are trained in prevention of mother to child transmission, testing, counseling, adherence, and other prevention.

“Malawi has been able to increase the number of nurses and midwives through NEPI,” she said.

The moment we started introducing post-graduate training and built housing for nurses, they stayed.

“Healthcare workers need support, it’s not only about the money,” Dr. Malata said. With the introduction of graduate level programs, more students are receiving their training in Malawi and staying in country once they graduate instead of going to Western countries for their education, she said.

“I don’t believe we should worry about retention,” she said. “We used to have international migration, but the moment we started introducing post graduate training and built housing for nurses, they stayed.”

This post originally appeared on Science Speaks.