medical volunteers to complement and augment the capacity of local health workers in PEPFAR countries.² The PEPFAR further identifies telemedicine as a tool to support these efforts.³ The experience of multiple organizations with experience in telemedicine, or more broadly defined, e-health, in low-resource countries has shown that while technology might be used to extend the presence of United States medical volunteers and build the capacity of local health professionals to combat HIV/AIDS, expectations about what they can achieve must be informed by a realistic understanding of the limited infrastructure and skills available to support them on the ground. Moreover, a commitment to using e-health should be driven by identified, real demands for improved access to information, data, training, etc., to combat HIV/AIDS and an understanding of how technology can meet those demands, rather than by a perception of e-health as an end unto itself. The most cost-effective and successful interventions are likely to be those that creatively leverage existing infrastructure and skills, such as low bandwidth e-mail, or those that introduce new technologies that are relatively inexpensive and easily adoptable, such as handheld computers and cellular telephones. A variety of e-health projects that follow these guidelines are already in existence and should be evaluated and considered as possible resource partners for a United States volunteer program before new projects are initiated.

Those countries hit hardest by HIV/AIDS face acute shortages of trained medical personnel. As Table E-1 indicates, the availability of physicians, nurses, and midwives per 100,000 people is limited in all 15 PEFAR countries.

The availability of health care in these countries can be expanded in many ways, including:

1. Recruiting and training new health workers (all cadres) from the local population.

2. Expanding the capacity of the existing local workforce by, for example, upgrading skills or expanding health workers’ reach into underserved areas.