Jhpiego seeks to ensure accessible, equitable, high-quality health services. Human resource shortages, especially in rural areas, have been a significant challenge to achieving this goal, especially because doctors, midwives and highly trained nurses often stay in cities and work in hospitals. For several decades, Jhpiego has promoted task shifting as a strategy to optimize the tasks and roles of existing health resources to reach as many people as possible with essential health services. In the early 1990s, Jhpiego empowered nurses to provide intrauterine device (IUD) and contraceptive implant services; by the early 2000s, Jhpiego was supporting midwives to provide lifesaving emergency obstetric and newborn care services, all tasks previously reserved for physicians. Jhpiego also trained many general doctors in Asia and Africa to perform cesarean sections and/or minilaparotomies for female sterilization—surgeries that were previously performed only at referral hospitals by specialists in gynecology and obstetrics. Similarly, the frontline prevention and treatment of cervical cancer have been placed in the hands of nurses and midwives, increasing access to these services for more than 108,000 women over the past five years.
With the growing need to address the HIV epidemic, Jhpiego has trained lay persons with a seventh grade education to provide screening for tuberculosis and hypertension, as well as counseling and testing for HIV, in the community. These lay persons have provided counseling and testing services to more than 900,000 persons in Mozambique alone. In response to international recognition that voluntary medical male circumcision is a key tool in the effort to prevent the spread of HIV, Jhpiego has played a leadership rolea cross sub-Saharan Africa in advocating for nurses to provide both adult and infant circumcision. In several countries, nurses perform circumcision independently; in others, nurses perform many but not all of the surgical steps. By harnessing the skills and commitment of nurses, many hundreds of thousands of men have received this procedure. Finally, in South Africa, Mozambique and Côte d’Ivoire, Jhpiego has advocated for expanded access to antiretroviral therapy through policies and programs that enable nurses and midwives to provide comprehensive care, including antiretroviral therapy for people living with HIV.
For too long, hundreds of thousands of people living in rural and underserved areas have been without basic maternal, newborn, reproductive and HIV-prevention care and services. By expanding the role and reach of the health workforce, Jhpiego is making lifesaving services—that were previously available only to the urban and the wealthy—accessible to people in all communities.