Examining approaches to workforce development and institutional strengthening in HIV programs, with attention to sustainability, knowledge retention, and systems integration.
Published January 2026 | Reading time: 10 minutes
Capacity building has been a consistent priority throughout the global HIV response, recognized as essential for sustainable program implementation and health system strengthening. Decades of investment in training, technical assistance, and institutional development have generated substantial learning about what approaches support lasting capacity development. Yet challenges persist in translating training into sustained behavior change, retaining trained personnel within the health workforce, and ensuring that capacity development serves broader health system goals beyond specific program requirements.
This analysis examines approaches to capacity building that prioritize sustainability, moving beyond episodic training toward systematic workforce development and institutional strengthening. The focus is on creating enduring capacity that continues to serve programs and health systems even as external support changes or concludes.
Training workshops have been a dominant modality for capacity building in HIV programs. While training can effectively transfer knowledge and introduce new skills, evidence increasingly shows that single training events rarely produce sustained behavior change in professional practice. Participants return to work environments where new approaches may not be supported, reinforced, or even feasible given system constraints. Without follow-up support, supervision, or mentoring, training effects diminish over time.
More effective approaches combine initial training with ongoing support for implementation. This might include post-training mentoring where experienced practitioners provide guidance as trainees apply new skills in their work settings. Site visits can identify implementation challenges and provide targeted problem-solving. Peer learning networks allow practitioners to share experiences and strategies. These follow-up mechanisms address the gap between learning new approaches and successfully implementing them in real-world contexts.
The work environment itself requires attention as a determinant of whether new capacity can be applied. Trained staff cannot implement new practices if necessary resources are unavailable, policies prohibit intended approaches, or supervisors do not support changes. Capacity building must address system enablers alongside individual competencies. This systems approach recognizes that individual capacity exists within organizational and health system contexts that either support or constrain application of new skills.
Investment in training produces limited returns if trained personnel leave their positions shortly after capacity building. Health workforce retention challenges are well documented, particularly in resource-constrained settings where trained professionals may be recruited to better-compensated positions elsewhere. Brain drain affects both international migration and internal movement from public sector to NGO or private sector positions.
Retention strategies must address underlying factors that influence career decisions. Compensation is one factor, though not always the most important. Professional development opportunities, supportive supervision, manageable workloads, and recognition of contributions all influence workforce satisfaction and retention. Career pathways that provide advancement opportunities within the public health sector can reduce attrition to other sectors. Creating environments where professionals can develop expertise and maintain engagement with their work serves retention alongside other program benefits.
Succession planning helps programs anticipate and respond to inevitable workforce turnover. Identifying and developing future leaders before current managers depart prevents knowledge loss and leadership gaps. Documentation of procedures and decision-making processes supports continuity when personnel change. Building depth in organizational capacity so that programs do not depend on single individuals for critical functions provides resilience against turnover.
Sustainable capacity extends beyond individual competencies to encompass institutional systems and processes. Institutional capacity includes organizational structures, management systems, financial administration, strategic planning processes, and quality assurance mechanisms. These institutional elements enable programs to function effectively and adapt to changing circumstances.
Strengthening institutional capacity requires different approaches than individual training. Organizational assessments can identify system weaknesses and priorities for strengthening. Process improvement methodologies help institutions examine and refine their operations. Management systems for human resources, finance, and information require development alongside technical program capacity. Governance structures including oversight mechanisms and accountability systems contribute to institutional effectiveness.
The relationship between technical assistance and institutional development warrants careful consideration. External technical assistance can supplement institutional capacity during development phases or address specific gaps. However, long-term reliance on external expertise may inhibit internal capacity development if institutions do not progressively assume functions initially performed by external partners. Transition planning should be explicit, with deliberate strategies for knowledge transfer and progressive handover of responsibilities to local institutions.
Pre-service education through medical schools, nursing programs, and public health training institutions shapes the foundational knowledge and skills of future health professionals. Integration of HIV-related content into pre-service curricula ensures that graduates enter the workforce with baseline competencies, reducing reliance on in-service training to address fundamental knowledge gaps.
However, pre-service curricula often lag behind current practice and emerging priorities. HIV treatment guidelines evolve more rapidly than curriculum revision cycles typically accommodate. Service delivery models implemented in programs may not be reflected in training institutions. Partnerships between training institutions and service delivery programs can facilitate curriculum updates and provide students with practical experience in contemporary approaches.
Faculty development in training institutions is itself a form of capacity building with multiplier effects. Training institution faculty who teach updated content prepare cohorts of students rather than training individual practitioners one by one. Investment in training institution capacity thus serves both immediate and long-term workforce development goals. Sustainable partnerships between programs and training institutions can maintain curriculum relevance over time.
Capacity building has historically relied heavily on North-South technical assistance, with expertise flowing from high-income to low-income countries. Increasingly, South-South collaboration enables countries with similar contexts to share experiences and expertise. Countries that have successfully addressed particular challenges can provide relevant guidance to others facing similar situations. Regional networks facilitate this peer learning while building collective capacity.
South-South approaches offer several advantages. Contextual similarity means that solutions developed in one setting may be more directly applicable elsewhere than approaches from very different contexts. Language and cultural familiarity can facilitate communication and relationship building. Demonstration that approaches have succeeded in comparable settings can enhance credibility and adoption. Regional centers of excellence can serve neighboring countries while maintaining ongoing learning from their own implementation experience.
However, South-South collaboration is not automatically superior to other approaches, and requires resources and intentional facilitation. Countries must have surplus capacity to share with others while maintaining their own program quality. Mechanisms for systematic knowledge sharing and mutual learning require development and support. Regional networks benefit from coordination structures that organize exchanges, document learning, and translate experiences into accessible guidance for wider application.
Assessing progress in capacity building presents methodological challenges. Training completion and participant satisfaction are readily measured but do not indicate whether capacity has actually increased or is being applied in practice. Knowledge tests before and after training show learning but not sustained retention or application. More meaningful assessment examines changes in practice, program performance, or health outcomes attributable to capacity building investments.
Frameworks for capacity assessment at individual, institutional, and system levels provide structures for more comprehensive evaluation. Individual assessments might examine competencies in specific domains through observation of practice or review of work products. Institutional assessments can evaluate management systems, governance structures, and organizational processes. System-level assessment might address policy frameworks, coordination mechanisms, or overall health workforce adequacy.
Attribution challenges complicate capacity building evaluation. Program improvements may result from multiple factors beyond capacity development alone. Isolating the specific contribution of training or technical assistance is often not feasible in operational settings. Contribution rather than attribution may be a more realistic evaluation standard, examining whether capacity building plausibly contributed to observed changes alongside other factors.
Many capacity building initiatives have been supported through external donor funding, particularly from major bilateral programs and global health initiatives. As countries develop economically and external funding transitions, questions of capacity building sustainability become acute. Programs must either mobilize domestic resources to continue capacity development or risk deterioration of hard-won capacity gains.
Integration of capacity building within government budgets and systems supports sustainability by embedding these functions in permanent structures rather than project-based mechanisms. Ministry of Health training units or national AIDS program capacity building departments can continue functions after external projects conclude. However, this requires political commitment to maintain investment in capacity development and recognition of capacity building as an ongoing need rather than a time-limited activity.
Efficiency in capacity building becomes increasingly important in resource-constrained environments. Cost-effective approaches might include technology-enabled learning that reduces travel and per diem costs, cascade training models that efficiently scale training delivery, or integration of capacity building across multiple health programs to share costs and avoid duplication. However, efficiency must be balanced against effectiveness; cheaper approaches that produce poor outcomes represent false economy.
HIV-focused capacity building has often occurred within vertical program structures with dedicated resources and systems. While this enabled rapid capacity development for HIV programs specifically, it sometimes created parallel systems that did not strengthen broader health sector capacity. Increasingly, approaches seek to integrate HIV capacity building with health systems strengthening, developing capacity that serves multiple programs and primary care services alongside HIV-specific functions.
This integrated approach recognizes that many competencies required for HIV programs are equally relevant to other health areas. Clinical skills in chronic disease management, laboratory systems capacity, health information systems expertise, and program management competencies benefit the health sector broadly. Investment in these cross-cutting capacities through HIV programs can be leveraged to strengthen the broader health system, increasing sustainability and maximizing return on investment.
Building sustainable public health capacity requires moving beyond episodic training toward systematic approaches that address individual competencies, institutional systems, enabling environments, and workforce retention. Sustainability is not automatic but requires intentional strategies including integration with government systems, development of local training capacity, establishment of supportive supervision mechanisms, and attention to factors that influence workforce retention.
The goal extends beyond developing capacity for current HIV programs to creating resilient health systems with enduring capacity to respond to HIV and other health challenges. This broader vision situates HIV capacity building within health systems strengthening, recognizing that sustainable gains serve public health goals beyond any single disease program. As the HIV response evolves, so too must approaches to capacity building, continuously adapting to new challenges while maintaining focus on lasting, locally-owned capacity development.