The use of lay counsellors for the prevention of mother-to-child transmission of HIV: a case study of Botswana’s national PMTCT programme

Through the successful implementation of prevention of mother-to-child transmission of HIV (PMTCT) interventions, paediatric AIDS has been largely eliminated in high-income countries. A number of factors, however, continue to impede the scale-up of PMTCT programmes in many Sub-Saharan African countries. One of the largest barriers to the scale-up of PMTCT programmes is the shortage of trained health workers. The health workforce crisis is contributing to the on-going high child mortality rates due to AIDS in Southern Africa despite the fact that there are affordable prevention mechanisms available. Innovative solutions are needed. This paper explores the implementation of one type of human resource intervention in Botswana’s national PMTCT programme aimed at addressing health worker shortages in order to scale-up PMTCT coverage and access – the Lay Counsellor. Botswana’s experience provides a potentially useful model for other countries in the region facing similar HIV epidemics in the context of health professional shortages.